Parents' expectations of their children's physicians and uncertainty regarding their children's health

Abstract

Functional symptoms, defined as symptoms in the absence of organic disease, are common among pediatric patients. Parents of functional pain patients often experience great uncertainty regarding their children's health status and have several expectations of physicians in their quest for answers. In terms of expectations, research suggests that parents expect that psychosocial concerns will be addressed and discussed and that symptoms will be acknowledged and explained -- all in the context of an emotionally supportive encounter with the physician. As for uncertainty, research suggests that parental uncertainty is comprised of illness ambiguity, lack of illness information, lack of clarity (in the context of systems of care and relationships between parents and providers), and unpredictability. The current study assesses how type of diagnosis (organic versus functional) and presentation of medical information (biomedical versus biopsychosocial) influences parents' uncertainty and the extent to which their expectations of the medical encounter are met. Mothers of school-age children were presented with a vignette describing a child with abdominal pain symptoms and completed a baseline questionnaire assessing their expectations about the information to be received from the physician following his evaluation of the child. Mothers then viewed one of four video vignettes that presented a medical evaluation of the child in the vignette that varied in its combination of presentation (biopsychosocial versus biomedical) and diagnosis (organic versus functional). After viewing the medical evaluation vignette, mothers then completed response questionnaires assessing the degree to which their expectations were or were not met as well as their uncertainty about the child's illness in light of the medical information just provided. Among all conditions, it was expected that mothers who received a biomedical explanation and a functional diagnosis would perceive their expectations as met to a lesser degree and would experience greater uncertainty. This study extends the literature by examining parent expectations and uncertainty with respect to the manner in which physicians communicate information to parents.