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 "Kids don't always disclose their health information to doctors and
parents, which means they try to negotiate serious health issues
without a trusted adult," said Dr. Melissa McKee of Albert Einstein
College of Medicine in Bronx, New York.
McKee, who wasn't involved with this study, has researched the
challenges of providing confidential care to adolescents. Teens are
more likely to seek health care and openly talk to doctors when
they're assured of privacy, particularly for issues related to
sexual behaviors, substance use and mental health.
"Kids need a trusted adult as they transition from a setting where
health decisions are typically made for them to adulthood when
they're completely in charge of their own health," she told Reuters
Health by phone.
Researchers at the Children's Hospital of Philadelphia surveyed 91
parents and teens ages 14 to 17 who attended a routine wellness
visit with a pediatrician. During a follow-up phone call two weeks
after the visit, parents reported whether their child met with the
pediatrician alone, rated the importance of alone time and talked
about the barriers of adolescent-pediatrician communication.
Ultimately, 86 percent of adolescents had time alone for part of the
wellness visit, ranging from five to 30 minutes. Fifty-three
parents, or 58 percent, said this private time had "a lot" of
importance, and another 25 parents (27 percent) ranked it a bit
lower but still said it had "quite a bit" of importance. Parents of
males were almost twice as likely to agree that alone time with the
doctor was important. Parents also said communication barriers
included rapport and familiarity with the pediatrician, privacy
concerns, emotional comfort, trust and support.
"We need to start creating opportunities for kids to have autonomy
with regard to health issues," McKee said. "It's not all or nothing
at a certain age. They don't suddenly become fully in charge of
themselves."
Future studies should focus on the gender difference, McKee added.
She and colleagues found that moms with daughters, in particular,
were nervous about losing the leadership role in health decisions
and didn't want their daughters to be exposed to certain topics
related to sexuality.
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"Some mothers believed certain conversations might even be a green
light for (their daughters) to be sexually active," she said. "The
gender difference is a consistent pattern we see."
To battle the barriers to communication with teens, some
pediatricians implement mandatory alone time early and build it into
annual visits as patients approach their teen years.
At age 10, for instance, doctors can begin talking to children about
privacy and confidentiality in health care settings. Then at ages 11
and 12, kids can consider whether they'd like alone time with the
doctor. By the teen years, pediatricians can build mandatory time
into the visit, even a few minutes with the parent out of the room,
said Dr. Joe Hagan of the University of Vermont College of Medicine
in Burlington, Vermont.
Hagan, who wasn't involved with this study, co-authored Bright
Futures, a national health promotion and prevention initiative of
the American Academy of Pediatrics, includes a section about the
ways doctors can discuss privacy and confidentiality with children,
as well as begin to build alone time into their appointments.
"If doctors in the same office are willing to set up mandatory alone
time, it's easy to move forward," Hagan told Reuters Health by
phone. "When everybody does it together, parents know to expect it
and aren't caught off guard."
SOURCE: http://bit.ly/2yjsq2t Journal of Adolescent Health, online
June 7, 2018.
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