title: Patient-centered communication and health assessment with youth.
abstract: BACKGROUND
  Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth.
  
  
  OBJECTIVE
  The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained.
  
  
  METHODS
  This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest).
  
  
  RESULTS
  Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction.
  
  
  CONCLUSIONS
  EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.
authors.affiliation: Kristy K. Martyn, PhD, RN, CPNP-PC, FNP-BC, is Acting Professor and Assistant Dean of Clinical Advancement, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Michelle L. Munro, MS, RN, CNM, FNP-BC, is Research Fellow, Cynthia S. Darling-Fisher, PhD, RN, FNP-BC, is Clinical Assistant Professor; David L. Ronis, PhD, is Research Scientist; Antonia M. Villarruel, PhD, RN, FAAN, is Professor, Nola J. Pender Collegiate Chair; and Michelle Pardee, DNP, RN, FNP-BC, is Clinical Assistant Professor, School of Nursing, University of Michigan, Ann Arbor. Hannah E. Faleer, BS, is Doctoral Student, Department of Psychology, Northern Illinois University, DeKalb. Nicole M. Fava, PhD, MSW, is Postdoctoral Fellow, Wayne State University, Detroit, MI.
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Martyn
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Munro
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Darling-Fisher
authors.forename: David L
authors.initials: DL
authors.lastname: Ronis
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Villarruel
authors.forename: Michelle
authors.initials: M
authors.lastname: Pardee
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Faleer
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Fava
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D000367:Age Factors; D003142:Communication; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009819:Office Visits; D057240:Patient Preference; D018802:Patient-Centered Care / Q000458:organization & administration*; D010817:Physician-Patient Relations; D011314:Preventive Health Services; D055815:Young Adult