Clinician-Parent Collaboration to Optimize Pediatric Weight ManagementFriday, September 23, 2011
Current approaches to managing childhood obesity recommend family-centred-care (FCC), as previous work has established that interventions focusing largely on the child alone, are rarely successful.
In order to better understand how collaboration between clinicians working in pediatric weight management and parents of overweight children looks in real life, Biagina-Carla Farnesi and colleagues from the University of Alberta, conducted focus groups and one-on-one interviews with parents and clinicians working in our paediatric obesity clinic, the results of which are now published in Patient Education and Counseling.
A family-centered, collaborative model of care was used to frame the data and develop codes/themes for analysis. Member checking and external reviews were conducted to verify emergent themes.
Not surprisingly, analyses revealed that effective collaboration between clinicians and parents included a positive therapeutic relationship, negotiation of health care delivery, and regular monitoring and evaluation.
These elements, consistent with a philosophy of family-centered care, emphasize the importance of tailoring health services to families’ needs, respect parents as experts, and identify clinician responsiveness as pivotal to partnerships with families.
In fact, parents consistently described dissatisfaction with care and a lower likelihood of seeking future care when clinicians deviated from these principles.
These results certainly suggest that pediatric weight management should not only be family-centered but must give parents the opportunity to actively engage in health services and negotiate their family’s care.
Or, as one parent remarked:
“I think it’s always a little bit frustrating to go into something like that and have somebody start firing solutions at you before they even know what the problems are”
This is important, as even the health professionals will unlikely have all the answers or can even be expected to know what works best for each family:
“[I]it’s kind of sending them away with, OK, this is what you want to do, let’s give it a try, and them coming back and saying OK, that didn’t work and figuring out why. And try and understand where they’re coming from”
The key findings of this study are perhaps best summarized in the following paragraph:
“Parents in our study disapproved of clinicians who provided lifestyle information and weight management recommendations before they spent time to ask families about their experiences, concerns, and needs. Parents perceived a lack of reciprocity and involvement when priorities and decisions are determined by clinicians exclusively; the implicit message communicated by clinicians in such encounters is that they are the ‘experts’, which tends to undervalue parents’ wisdom and family experiences. Not only do these situations represent a power imbalance, but they are the antithetical to the FCC philosophy whereby parents are ‘experts’ about their children and families, and this information is on par with the health information provided by professionals.”
For clinicians it is important to realize, that in order to engage collaboratively and effectively with families, their sensitivity about obesity and weight management should be heightened to ensure that their verbal (and non-verbal) communication conveys respect, trust, and openness towards the family.
Such an approach will be essential to create an environment that can enhance collaboration, establish rapport, and improve health outcomes.
New York, NY
Farnesi BC, Newton AS, Holt NL, Sharma AM, & Ball GD (2011). Exploring collaboration between clinicians and parents to optimize pediatric weight management. Patient education and counseling PMID: 21925825