title: Clinical conversations about health: the impact of confidentiality in preventive adolescent care.
abstract: OBJECTIVE
  To better understand how confidentiality impacts the delivery of preventive adolescent health care by examining adolescent and parent beliefs and the relationship between confidentiality and the number and subject matter of health topics discussed at the last visit.
  
  
  METHODS
  This study represents a secondary analysis of nationally representative online survey data collected from adolescents aged 13-17 years (N = 504) and parents of adolescents aged 13-17 years (N = 500). Descriptive statistics were conducted on confidentiality variables of interest. Analysis of variance and Scheffe post hoc tests were computed to determine whether the mean number of topics discussed varied by level of confidential consultation provided. Associations between confidential consultation and health topics discussed at the last visit were examined using multivariate logistic regression.
  
  
  RESULTS
  Approximately, half of both samples reported provision of confidential consultation. Eighty-nine percent of parents believed adolescents should be able to speak with providers alone, yet 61% preferred to be in examination room for the entire visit. Nearly half of all adolescents believed parental presence impacted conversation. Mean number of topics discussed was significantly higher when a visit was partially confidential (4.11 ± 3.05; p = 0) versus when a visit was not confidential (2.76 ± 2.68; p = 0). There were significant associations between confidential consultation and discussions about 8 of 11 health topics.
  
  
  CONCLUSIONS
  Confidential consultation significantly impacts the number and subject matter of health topics discussed. A split-visit confidentiality model for adolescent preventive care visits may result in clinical conversations that address more topics. This arrangement may also appeal to parents who have mixed feelings about confidentiality.
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc., Indianapolis, Indiana. Electronic address: amylewis@iu.edu.
authors.forename: Amy Lewis
authors.initials: AL
authors.lastname: Gilbert
authors.affiliation: Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Vaughn I
authors.initials: VI
authors.lastname: Rickert
authors.affiliation: Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Aalsma
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D000295:Adolescent Medicine; D000328:Adult; D003219:Confidentiality; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010287:Parent-Child Relations; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000458:organization & administration*; D035502:Trust
keywords: Adolescent health; Confidential consultation; Confidentiality; Preventive health care