Pediatric Academic Societies Abstracts for 2001

COMMUNICATING A DIAGNOSIS OF ASTHMA: MY CHILD HAS WHAT? SA Finch, LN Werk, RC Wasserman and CJ Homer. Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove, IL; Nemours Children's Clinic, Orlando, FL; and National Initiative for Children's Healthcare Quality, Boston, MA. Accepted for a poster symposium presentation at the 2001 Pediatric Academic Societies? Annual Meeting.

BACKGROUND: Communicating the diagnosis (dx) of asthma in young children is important to managing the disease, but may be made more confusing by the use of euphemistic synonyms.

OBJECTIVE: To compare what practitioners (MDs) thought and said with what parents of young wheezing children heard and felt.

DESIGN/METHODS: From 11/99-6/00, 34 MDs in 21 PROS practices prospectively enrolled 612 consecutive patients >12 and <60 months presenting with respiratory symptoms. Each parent completed a pre-visit survey and both parent and MD completed post-visit surveys. MDs recorded dx(s) they considered likely as well as those told parents; parents recorded dx(s) they heard. Patients were excluded (85) if the parent reported being told in past that child had asthma. Analyses were further confined to patients told by MDs at this visit to have asthmatic/wheezy bronchitis (A/W bronchitis), reactive airway disease (RAD) or asthma.

RESULTS: MDs reported considering one of the three dxs likely in 62 cases, but only told parents in 46 of these cases. Agreement between MDs and parents within each dx was modest: A/W bronchitis (25%); RAD (8%); and asthma (53%).

	MD told A/W Bronchitis	MD told RAD	MD told Asthma	MD told Other Respiratory Illness
Parent heard A/W Bronchitis	1	3	2	7
Parent heard RAD	0	2	0	3
Parent heard Asthma	0	5	9	0
Parent heard Other Respiratory Illness	3	15	6	449
TOTAL	4	25	17	459

In the post-visit survey, among parents who heard one of these three dxs, 50% reported already suspecting that their child might have the dx and 58% felt relieved after being told by the MD, with no difference in relief between the asthma (58%) and the A/W bronchitis/RAD (50%) dxs.

CONCLUSIONS: MDs often fail to tell parents when they suspect asthma or one of its diagnostic synonyms. Parents frequently do not hear the dx that the MD reports telling. When MDs use the dx of asthma, it is received no differently than the other dxs. MDs should call asthma asthma.

DISCLOSURE: Funding for this study was provided by Merck & Co, Inc with additional support from the Health Resources and Services Administration Maternal and Child Health Bureau.