PEDIATRICS Vol. 88 No. 2 August 1991, pp. 351-358
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Increasing Patient Knowledge, Satisfaction, and Involvement: Randomized Trial of a Communication Intervention

Catherine C. Lewis PhD1, Robert H. Pantell MD1, and Lee Sharp PhD1

1 From the Division of General Pediatrics, University of California, San Francisco

A brief educational intervention to promote effective communication between physicians, children, and parents during pediatric office visits was designed and tested. A randomized clinical trial involving 141 children (5- to 15-year-olds) tested the effectiveness of the intervention to improve the process and outcome of medical care. The intervention was contained in three brief videotapes (one each for parents, physicians, and patients) and in accompanying written materials. Materials were designed to build skills and motivation for increased child competence and participation during pediatric medical visits. Control subjects saw health education videotapes and received materials comparable in length with those of experimental subjects. Postintervention medical visit process was analyzed using videotapes of visits. Visit outcomes, assessed with standardized instruments and interviews, included children's rapport with physicians, children's anxiety, children's preference for an active health role, children's recall of information, parents' satisfaction with the medical visit, and physician satisfaction. Results indicated that physicians in the intervention group, compared with their counterparts in the control group, more often included children in discussions of medical recommendations (50% vs 29%, t = 2.39, P < .05); that children in the intervention group, compared with control children, recalled more medication recommendations (77% vs 47%, P < .01) and reported greater satisfaction and preference for an active health role; and that the intervention and control groups did not differ in parent satisfaction, physician satisfaction, or child anxiety. The results suggest that a brief educational intervention administered during waiting room time can positively impact physician-child rapport and children's preference for an active role in health and their acquisition of medical information.

Key Words: communication • physician-patient relationship

Submitted on May 18, 1990




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