For Teachers & Professionals

Facilitators for Patient-centered Communication with Adolescents – part 2

Adolescents face unique challenges in their daily lives. Implementation of adolescent-friendly standards has been associated with adolescent use of services and reductions in teen pregnancy. Patient-centred care and shared decision-making have also been emphasized as a critical but underutilized approach to further support adolescent use of and adherence to contraceptives and improved sexual and reproductive health outcomes. Barriers to adolescent care are related to confidentiality, sexual-related health-related stigma, and constraints on time and space.

What are some facilitators of communication?

1. Direct Communication

Direct, respectful, and open communication with providers is highly valued. Adolescents feel that communication around sensitive subjects worked best when the clinician speaks to the patient directly, rather than the parent and if the parent is present, it is better when the young patient is directly addressed. The need for confidentiality and the importance of directing questions to adolescent patients must be balanced with parental involvement, which depends on the situation and the teen's preferences. 

Adolescents might not always know what they should ask, how to begin a sensitive conversation, or how to answer providers’ questions. Being the first to start the conversation may open the road to further discussion. Providers describe the need to provide clear health information, as well as the importance of building rapport with patients so that they feel more comfortable asking “awkward” questions about sexuality and reproduction. If the adolescent is shy or introverted, asking them to think about and write down questions for the following appointment might be a good strategy.

Taking the time to provide reliable and confidential information concerning sexual and reproductive health, and discussing preventive health measures is also important. 

2. Adolescent-driven decision making

Adolescents appreciate being part of the decision-making process when trying to decide on treatments, for example when it comes to gynaecological concerns or contraceptives. Adolescents might consult with family members, but they want to feel that it was ultimately their decision. Decision-making also works better when providers share their reasoning for a diagnosis or prescribe a particular medication or contraceptive. 

For some, parental presence could inhibit adolescent-physician communication, whereas others indicated that parental presence facilitated adolescents' willingness to speak up. Parental presence during the initial part of the visit might be used to facilitate adolescent comfort with open communication with physicians when they have time alone. Talking alone might enhance the feeling of autonomy and responsibility over their own life decisions.

3. Use supports

Use other materials such as leaflets to share health information. Providing young patients with materials they can read at home may also enhance their process of self-driven decision-making. Identifying and providing reputable health information sources is more important rather than letting the patient alone. Using support may also overcome embarrassment concerns at the beginning. Sometimes handouts are quickly forgotten, so it might be helpful to provide websites where adolescents can search for information by themselves, which may be discussed in the following appointments. As it is reported by a patient: “Just knowing what other resources are out there would be helpful to me. Like I was telling you, having some sort of a guide prior to the conversation...”

Effective communication with adolescents is important with respect to visit satisfaction, adherence to treatment recommendations, perceptions of control and competence, and decisions to seek future health care. 

REFERENCES

Frederick, NN, Campbell, K, Kenney, LB, Moss, K, Speckhart, A, Bober, SL.(2018). Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective. Pediatr Blood Cancer.; 65:e27087. https://doi.org/10.1002/pbc.27087 

Brault MA., Curry LA., Kershaw TS., Singh K., Vash-Margita A., CamengaDR., (2021). Supporting Patient-centered Communication on Adolescent Sexual and Reproductive Health - Perspectives to Build an Appointment Planning Tool, Journal of Pediatric and Adolescent Gynecology, Volume 34, Issue 5,, Pages 725-731, ISSN 1083-3188, https://doi.org/10.1016/j.jpag.2021.04.009.

Miller VA., Friedrich E., García-España JF., Mirman JH., Ford CA., (2018). Adolescents Spending Time Alone With Pediatricians During Routine Visits: Perspectives of Parents in a Primary Care Clinic, Journal of Adolescent Health, Volume 63, Issue 3, Pages 280-285, ISSN 1054-139X, https://doi.org/10.1016/j.jadohealth.2018.01.014.