title: Correlates of type and quantity of child communication during pediatric subspecialty encounters.
abstract: OBJECTIVE
  Understanding the factors associated with child communication during subspecialty encounters may inform interventions promoting shared decision-making in chronic disease management. Objectives were to (1) describe the quantity and quality of child communication during outpatient subspecialty encounters and (2) determine if and how the quantity and quality of child communication vary by demographic and visit characteristics.
  
  
  METHODS
  We videotaped subspecialty clinic encounters involving 20 health care providers and 155 children with one of the following conditions: acute lymphoblastic leukemia (consolidation/maintenance), persistent asthma, cystic fibrosis, type 1 diabetes, and obesity. The Roter interaction analysis system was used to code child utterances into one of 10 discrete categories.
  
  
  RESULTS
  Children exhibited a mean of 15% of all utterances made during clinical encounters. Children spoke more during obesity encounters.
  
  
  CONCLUSIONS
  Similar to the findings of studies in primary care settings, children spoke infrequently during the subspecialty visits, and the most common utterances tended to be replies to questions from adults.
  
  
  CONCLUSIONS
  In this study, there was relatively higher engagement of children during obesity clinic encounters in the area of lifestyle choices. Strategies used to engage children in conversation in obesity clinics may be useful for engaging children in other subspecialty clinics.
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA. Electronic address: Vanessa.vigilante@nemours.org.
authors.forename: Vanessa Ann
authors.initials: VA
authors.lastname: Vigilante
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Jobayer
authors.initials: J
authors.lastname: Hossain
authors.affiliation: Nemours Children's Clinic, Jacksonville, FL, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Wysocki
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Iman
authors.initials: I
authors.lastname: Sharif
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D005791:Patient Care; D000072143:Pediatricians; D010817:Physician-Patient Relations; D012923:Social Class
keywords: Child; Communication; Pediatric; Specialty