Patient-Provider Trust as a Key Component of Prenatal Screening for Adverse Childhood Experiences (ACES): A Concept Analysis.
Paige D Gilliland, Jennifer E Phipps, Breän Derret and 4 others
PMID 38946242WHAT IT FOUND
Prenatal ACE screening is described as trust-supporting when offered after several visits, by a familiar provider, with privacy, explanation, and permission before charting.
Themes from 32 papers describe conditions, not proof screening improves outcomes.
Key findings
01The concept analysis identified timing, provider familiarity, cultural competence, demystifying trauma, open dialogue, and privacy as attributes of trust in prenatal ACE screening.
02One included study reported that 53% of respondents said the ACE conversation increased trust in their clinician and 47% said it did not.
03In one included study, 80.3% of women preferred their midwife or physician to administer the ACE screener rather than a clinic nurse, mental health professional, home visiting public health nurse, social worker, medical assistant, or dietician, and 80% wanted permission before the ACE score was recorded in the chart.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a concept analysis, not a trial or cohort study, so it cannot show that any trust strategy improves screening uptake, trust, or birth outcomes. The search did not include trust as a term because the authors said no studies explicitly evaluated trust in prenatal ACE screening. The search covered 2010 to 2021; the authors did a rapid review of 2022 to 2023 and found no additional relevant papers. The included articles varied in trauma measures and populations, and the authors note little literature discusses racial, ethnic, and cultural barriers to screening. The claim that the variety of included studies allows greater generalizability is an author interpretation, not a measured result.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not read this as evidence that prenatal ACE screening improves trust or birth outcomes. It is a concept analysis of 32 articles, and one included study found 47% of respondents said the ACE conversation did not increase trust in their clinician.