title: Opening Pandora's box: parental anxiety and the assessment of childhood murmurs.
abstract: BACKGROUND
  Most family physicians and pediatricians recognize the induction of parental anxiety when a newly diagnosed childhood murmur is discussed with a child's parent.
  
  
  OBJECTIVE
  To assess parental anxiety before and after consultation with a pediatric cardiologist for assessment of a childhood murmur. The study investigated the relationship between anxiety and parental understanding of murmurs, and assessed the possible role of the primary physician's initial diagnosis of the child's murmur on the anxiety level of parents.
  
  
  METHODS
  One hundred ninety-five consecutive parents who presented with their child to the Alberta Children's Hospital Cardiology Clinic, Calgary, Alberta, were recruited. The children were referred for an initial consultation with a pediatric cardiologist for assessment of a heart murmur noted previously by the referring physicians. Before consultation, the patients were divided into three murmur groups for diagnosis: innocent, pathological and unknown. Anxiety questionnaires, as well as questionnaires assessing basic parent understanding of childhood murmurs, were administered to one of the parents pre- and postconsultation.
  
  
  RESULTS
  The initial diagnosis given to the caregiver by the primary care physician as the reason for referral did not seem to affect the level of parental anxiety within groups. As expected, postconsultation anxiety levels were significantly higher in parents whose children received a pathological diagnosis from the pediatric cardiologist. A significant drop in parental anxiety post-consultation was seen in all parent groups, including parents of a child diagnosed with a significant cardiac problem or pathology requiring further investigation and/or cardiac follow-up. There was a consistent correlation between higher scores on parental understanding and lower levels of parental anxiety.
  
  
  CONCLUSIONS
  The present study confirms that the finding of a childhood murmur by the family doctor or pediatrician induces significant parental anxiety, even when the presumptive diagnosis is that of an 'innocent' murmur. Pediatric cardiology consultation decreases parental anxiety, even in parents whose child has been given a diagnosis of pathology. The correlation between poor understanding of murmurs and high parental anxiety suggests that further study is required on the role of the referring physician in augmenting parental understanding of the term 'heart murmur' and the referral process.
authors: Alberta Children's Hospital, Calgary, Canada. amgillis@ucalgary.ca
authors: R M
authors: RM
authors: Giuffre
authors: I
authors: I
authors: Walker
authors: S
authors: S
authors: Vaillancourt
authors: S
authors: S
authors: Gupta
mesh_terms: D000328:Adult; D001007:Anxiety; D002648:Child; D005260:Female; D006337:Heart Murmurs / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology*; D006801:Humans; D008297:Male; D009864:Ontario; D010290:Parents / Q000523:psychology*; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires