Evaluating provider communication in pediatric chronic kidney disease care using a global coding system.
Shayna S Coburn, Wynne A Callon, Michelle N Eakin and 6 others
PMID 32147305WHAT IT FOUND
In 99 pediatric CKD visits, providers often greeted and built rapport well but rarely asked the young person's or caregiver's perspective or checked understanding.
Adherence was not asked in 20% of visits, and providers earned higher communication ratings with female patients than male patients.
Key findings
01Providers were rated highest for starting the visit, gathering information, and developing rapport, and lowest for the patient's perspective, checking understanding or agreement, and providing structure.
02In 97% of visits, providers did not ask the parent or patient's opinion about CKD; only 5% explicitly checked understanding and agreement with the plan.
03Average communication ratings were higher in visits with female AYAs than male AYAs across domains (1.19 vs 0.97).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Providers knew visits were recorded, which may have changed behavior. Only two female coders scored visits, so gender bias could affect ratings. Provider gender differences could not be examined because only four providers were male. Audio-only data meant non-verbal communication was not assessed. The communication rating system has not been tested for associations with health outcomes. The sample was pediatric nephrology subspecialty care, so results may not apply to primary care or other ages. The coding system did not distinguish whether a skill was absent or done poorly.
Declared interests
No author conflicts or funding declaration are given in the supplied text; the publication types note NIH extramural support.
The easy way to misread this
Do not conclude that teach-back or open adherence questions improve CKD adherence or health outcomes. This study observed communication during visits and did not test these communication behaviors or link them to patient outcomes.