Child Health Providers' Precautionary Discussion of Emotions during Communication about Results of Newborn Genetic Screening

Objective: To demonstrate a quantitative abstraction method for Communication Quality Assurance projects to assess physicians' communication about hidden emotions after newborn genetic screening. Design: Communication quality indicator analysis. Setting: Standardized parent encounters performed in practicing physicians' clinics or during educational workshops for residents. Participants: Fifty-nine pediatrics residents, 53 pediatricians, and 31 family physicians. Intervention: Participants were asked to counsel standardized parents about a screening result; counseling was recorded, transcribed, and parsed into statements (each with 1 subject and 1 predicate). Pairs of abstractors independently compared statements with a data dictionary containing explicit-criteria definitions. Outcome Measures: Four groups of "precautionary empathy"behaviors (assessment of emotion, anticipation/validation of emotion, instruction about emotion, and caution about future emotion), with definitions developed for both "definite" and "partial" instances. Results: Only 38 of 143 transcripts (26.6%) met definite criteria for at least 1 of the precautionary empathy behaviors. When partial criteria were counted, this number increased to 80 of 143 transcripts (55.9%). The most common type of precautionary empathy was the "instruction about emotion" behavior (eg, "don't be worried"), which may sometimes be leading or premature. Conclusions: Precautionary empathy behaviors were rare in this analysis. Further study is needed, but this study should raise concerns about the quality of communication services after newborn screening.