Patient-provider communication in nephrology care for adolescents and young adults |
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| Affiliation: | 1. Children''s National Health System, George Washington University, Washington, DC;2. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH;3. University of Pittsburgh Medical Center, Department of Physical Medicine and Rehabilitation, Pittsburgh, PA;4. Center for Development Behavior and Genetics, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY;5. MedStar Washington Hospital Center/Children''s National Medical Center, Georgetown University, Washington, DC;6. Wayne State University School of Medicine, Pediatric Nephrology and Hypertension, Children''s Hospital of Michigan, Detroit, MI;7. Department of Urology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN;8. Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD;9. Self-Management Science Center, College of Nursing, University of Wisconsin-Milwaukee (UWM), Children''s Hospital of Wisconsin (CHW), Milwaukee, WI;10. Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN;11. James Buchanan Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, MD |
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| Abstract: | ObjectiveTo compare the relative quantity of talk between providers, caregivers, and adolescents and young adults (AYAs) with chronic kidney disease (CKD) and how communication differs by age.MethodsDuring nephrology clinic visits, conversations between AYAs with CKD (N = 99, ages 11–20, median = 15), their caregivers, and providers (N = 19) were audiotaped and coded using the Roter Interaction Analysis System. Linear mixed models tested AYA age differences in talk frequency by AYAs, caregivers, and providers. Post-hoc analyses tested differences in talk using AYA age groups.ResultsDuring clinic visits, providers spoke the most (63.7%), and caregivers spoke more (22.6%) than AYAs (13.7%). Overall talk differed by AYA age in AYAs (p < 0.001) and caregivers (p < 0.05), but not providers. Higher AYA age was associated with more AYA talk (biomedical information-giving, partnering, rapport-oriented) and less caregiver biomedical information-giving (ps < 0.001–0.05). In post-hoc analyses, young adults talked more than adolescents; caregiver talk decreased in the middle-adolescent group.ConclusionsIncreases in AYA talk occur primarily in young adulthood, whereas caregiver talk decreases in middle adolescence. This may indicate an appropriate developmental shift but raises concerns about conversational gaps during middle-adolescence.Practice implicationsDuring transition-oriented treatment planning, providers should engage both AYAs and caregivers to avoid potential gaps in communication. |
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| Keywords: | Patient-provider communication Adolescents Young adults Caregivers Chronic kidney disease Nephrology Transition Subspecialty Pediatric |
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