title: Shared Medical Appointments marginally enhance interaction between patients: an observational study on children and adolescents with type 1 diabetes.
abstract: OBJECTIVE
  To examine informational and emotional patient-provider and patient-patient communication sequences (i.e. cues and subsequent responses) during Shared Medical Appointments (SMAs) for children and adolescents with type 1 Diabetes Mellitus (T1DM) and their parents.
  
  
  METHODS
  57 children/adolescents with T1DM and 36 healthcare providers participated in ten SMAs in seven Dutch hospitals. Parents were present in six SMAs. Video-recordings were made. Communication sequences, including informational and emotional cues and responses were rated using an adaptation of the Medical Interview Aural Rating Scale.
  
  
  RESULTS
  143 patient-initiated cues were identified, followed by 140 provider responses and 30 patient responses. Patients gave more informational than emotional cues. Informational cues were mostly medical-related. Subsequent responses provided by providers and patients contained mostly appropriate information. We identified 17 patient and four parent cues with multiple responses.
  
  
  CONCLUSIONS
  Almost all cues were identified by healthcare providers and responded to in an appropriate manner. Cues not followed by a provider's response were picked up by other patients. Providers acted as mediator between a patient cue and another patient's response, thereby stimulating the interaction during SMAs.
  
  
  CONCLUSIONS
  Professionals could more explicitly invite all participants to interact with each other, and enable them to have their share in the communication process.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. j.noordman@nivel.nl
authors.forename: Janneke
authors.initials: J
authors.lastname: Noordman
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
mesh_terms: D000293:Adolescent; D001071:Appointments and Schedules; D002648:Child; D003142:Communication; D003463:Cues; D003922:Diabetes Mellitus, Type 1; D005260:Female; D006126:Group Processes; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009426:Netherlands; D010045:Outpatients; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D014743:Videotape Recording; D055815:Young Adult
keywords: Communication; Diabetes type 1; Pediatrics; Sequence analysis; Shared Medical Appointment