DOCTOR-CHILD COMMUNICATION: IMPROVING HEALTH OUTCOMES

我们建议测试一种旨在促进积极， 医生和儿童在办公室之间的有效沟通 设置. 我们假设拟议的干预措施将增加 儿童参与医疗服务，并提高 认知适当性的医生的沟通，以儿童， 实质性领域。 此外，我们假设拟议的干预措施 将增加儿童的知识和积极参与他们的健康 提高父母对医疗服务的利用率， 医生满意度 在哮喘儿童的子样本中， 干预措施，以提高儿童的管理技能，减少父母的 利用医疗服务。 我们的教育干预针对所有三个参与者， 儿科医疗遭遇：医生、儿童和父母。 的 干预措施包括录像带和书面材料。 主要 我们的沟通模式的组成部分是：（1）医生应该增加 在实质性内容领域与儿童直接沟通;（2） 应在认知上适当的时间向儿童提供信息， （3）儿童应积极参与医学访谈 （4）鼓励家长表达意见， 以明确的议程形式表达他们的关切。 180名7-14岁的患者及其陪同父母， 将对62名医生进行研究。 80名儿童的子样本将是慢性的 哮喘患者 一半的医生将被随机分配到 实验组;一半将被分配到控制组。 分配 病人和父母的分配将决定他们的 医生 将研究三种类型的结果：面试过程; 患者、父母和医生的就诊后结局;以及费用 干预的有效性。 将使用方差分析和多元回归分析数据。 该项目的长期目标是：1）展示 可输出的教育干预措施在提高 医学访谈的过程; 2）证明因果关系 沟通过程与医疗结果的关系 包括儿童管理自身健康和疾病的能力， 父母利用医疗服务的有效性。

We propose to test a communication intervention designed to promote active, competent communication between physicians and children in an office setting. We hypothesize that the proposed intervention will increase children's participation in medical encounters and increase the extent and cognitive appropriateness of physicians' communication to children in substantive areas. Further, we hypothesize that the proposed intervention will increase children's knowledge and active participation in their health care, improve parents' utilization of medical services and improve physician satisfaction. In subsamples of asthmatic children we expect the intervention to improve children's management skills and reduce parents' utilization of medical services. Our educational intervention targets all three participants in the pediatric medical encounter: physician, child and parent. The intervention is contained in videotapes and written materials. The major components of our communication model are: (1) Physicians should increase their direct communication with children in substantive content areas; (2) Information should be provided to children at a cognitively appropriate level; (3) Children should actively participate in the medical interview and express their concerns; (4) Parents should be encouraged to express their concerns in the form of a clear agenda. One hundred and eighty patients ages 7-14, their accompanying parents, and 62 physicians will be studied. A subsample of 80 children will be chronic asthmatics. Half the physicians will be randomly assigned to an experimental group; half will be assigned to a control group. Assignment of patients and parents will be determined by the assignment of their physicians. Three types of outcomes will be studied: interview process; post-encounter outcomes for patient, parent and physician; and cost effectiveness of the intervention. Data will be analyzed using analysis of variance and multiple regression. The long term objectives of this project are: 1) to demonstrate the effectiveness of an exportable educational intervention in enhancing the process of the medical interview; and 2) to demonstrate the causal relationship between the communication process and medical outcomes including children's ability to manage their own health and illness and parents' effectiveness in utilizing medical care.