چکیده (انگلیسی):

Background:Communication within primary care consultations for children with acute illness can be problematic
for parents and clinicians, with potential misunderstandings contributing to over–prescription of antibiotics. This
review aimed to synthesise the evidence in relation to communication and decision making in consultations for
children with common acute illness.
Methods:A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, SSCI, SIGLE, Dissertation Express and
NHS economic evaluation databases was conducted. Studies of primary care settings in high income countries
which made direct observations of consultations and reported qualitative data were included. Included studies
were appraised using the process recommended by the Cochrane Qualitative Methods Group. Credibility was
assessed as high for most studies but transferability wasusually assessed low or unclear. Data were synthesised
using a meta–ethnographic approach.
Results:Thirty–five papers and 2 theses reporting on 13 studies were included, 7 of these focussed on children
with respiratory tract infections (RTI) and the remaining 6 included children with any presenting illness. Parent
communication focussed on their concerns and information needs, whereas clinician communication focussed
on diagnosis and treatment decisions. During information exchanges, parents often sought to justify the need
for the consultation, while clinicians frequently used problem minimising language, resulting in parents and
clinicians sometimes talking at cross–purposes. In the context of RTIs, a range of parent communication
behaviours were interpreted by clinicians as indicating an expectation for antibiotics; however, most were
ambiguous and could also be interpreted as raising concerns or requests for further information. The perceived
expectation for antibiotics often changed clinician decision making into clinician–parent negotiation.
Conclusions:Misunderstandings occurred due to parents and clinicians talking at cross purposes about the
‘seriousness’ of the illness and because parents’ expressions of concern or requests for additional information
were sometimes perceived as a challenge to the clinicians’ diagnosis or treatment decision. This modifiable
problem may be an important contribution to the unnecessary and unwanted prescribing of antibiotics. Primary
care clinicians should be offered training to understand parent communication primarily as expressions of
concern or attempts at understanding and always tocheck rather than infer parental expectations.