Parents, pediatricians differ on key concepts of partnership

A strong partnership between parents and pediatricians is critical to providing effective health care for children. But researchers at the Wright State University Boonshoft School of Medicine Department of Pediatrics found that parents and pediatricians don’t necessarily share the same views of partnership.

Richard C. Rapp, Ph.D., and John M. Pascoe, M.D., of the Department of Pediatrics at the Boonshoft School of Medicine, coauthored the study “Clarifying Parents’ and Pediatricians’ Views of Partnership,” which was published in the September-October issue of the Journal of the American Board of Family Medicine.

They found that nearly 95 percent of surveyed parents valued a pediatrician being available any time of day or night, while only about 45 percent of the pediatricians agreed. They also found that nearly 99 percent of parents thought avoiding legal issues interfering with a pediatrician’s relationship with a parent and child was important, while only about 62 percent of pediatricians agreed.

Rapp and Pascoe developed a partnership survey that asked parents of patients visiting an affluent suburban private practice and a federally qualified health center in addition to two groups of pediatricians to review 61 partnership concepts and identify those they considered as being important to partnership. One sample of pediatricians was from the Southwestern Ohio Ambulatory Research Network (SOAR-Net), a primary care, pediatric care practice-based research network. The second sample of pediatricians was from the Western Ohio Pediatric Society, a group of general pediatricians in and around Dayton.

Parents from the suburban practice and the health center as well as pediatricians agreed that 42 of the concepts were important to partnership. Of those, 16 were dropped because they were redundant, leaving 26 that were considered important by both sets of parents and pediatricians. Some of the concepts identified with the highest levels of importance included:

• Providing parent with skills or information to help parent’s child succeed;
• Being honest with parent, even when there is bad news;
• Treating child and parent with dignity;
• Clearly explaining what the treatment is;
• Making sure parent/youth understand the plan;
• Explaining problem and treatment in terms parent/youth can understand; and
• Making sure the parent/youth really understand the problem/treatment.

Parents from both the suburban practice and the health center identified five concepts that they believed contributed to partnership. However, pediatricians did not identify these concepts as important for a strong parent-pediatrician partnership. Those five concepts included:

• Avoiding legal issues interfering with pediatrician relationships with parent and child;
• Discussing child’s care with other professionals;
• Being available any time of day or night;
• Spending as much time as possible with parent/child; and
• Agreeing with pediatrician on treatment plan.

The pediatricians surveyed identified the following concepts with high importance, while the parents did not place as high of a value on these concepts:

• Making recommendations about a course of treatment;
• Involving parent in defining the problem;
• Including the child in a discussion of his/her condition;
• Giving specific reassuring information; and
• Giving advice on how to stay healthy in future.

Rapp explained that partnership between pediatricians and parents is not a one-size-fits-all phenomenon.

“Although all three groups agreed on many concepts, there were meaningful differences, both among parents and pediatricians and between parent groups,” Rapp said. “It is up to pediatricians to be sensitive to the potential differences between their own views of partnership and those of parents. Careful listening and questioning can help pediatricians be aware what the differences are from parent to parent.”

Pascoe explained that the idea for this study came from a conference he attended four years ago. One of the presenters, who had raised a son with a chronic disability, included a slide in her presentation about the importance of partnership between professionals who care for children and their families and parents.

“Her excellent presentation reminded me of how important partnership is between parents and pediatricians,” Pascoe said.

In his pediatric practice, listening to the parents is very important to understanding how to best help them and their children. Some parents want him to tell them what to do. Others want to be included in decision-making about the treatment plan.

“I’m here to meet these parents where they are and help them,” he said. “Partnership improves the health care outcomes among children.”