Article type
Year
Abstract
Background: Most doctors receive little clinical training on managing parents’ anxiety in a paediatric emergency department (ED), and none on how to communicate information.
Objectives: To investigate the causes of anxiety and strategies (shared decision-making and parent-centred approach) that doctors can use for managing parental fear and concern in a paediatric ED, and summarise the information in a systematic conceptual map.
Methods: From personal experience and a comprehensive literature search by using multiple search strategies (ASSIA and ISI Web of Knowledge databases) I sought the three key determinants triggering parental anxiety. Titles and abstracts were screened to identify quality studies to include, key themes were coded by hand, higher order themes were synthesised into three maps, and lines of arguments underlined in a final synthesis map.
Results: The three key determinants triggering parental anxiety were changing family dynamics, parental preferences and expectations, and inadequate paediatricians’ strategies for coping with parental anxiety. The search yielded 8501 papers, including 1004 potentially relevant studies. Subsequent screening excluded psychiatric studies and yielded 112 papers that met inclusion criteria. Overall I found 46% qualitative studies, 21% observational and prospective studies, 17% narrative reviews, and 16% other studies including two RCTs and two grounded-theory studies. Research took place mostly in the USA and rarely in developing countries. The three final mapped lines of arguments triggering parental anxiety were having a single child, gut feelings from previous hospital experience, pain-catastrophizing and fever-phobia.
Conclusions: Managing parental anxiety is a major and often neglected problem in a paediatric ED that needs a parent-centred approach based preferably on shared-decision making. Health-care professionals can reduce anxiety and save hospital resources by listening to parents, avoiding blaming them for coming or confounding emotions with psychopathology, reassuring them, reducing children’s pain as soon as possible, without trying to solve complex clinical problems immediately.
Objectives: To investigate the causes of anxiety and strategies (shared decision-making and parent-centred approach) that doctors can use for managing parental fear and concern in a paediatric ED, and summarise the information in a systematic conceptual map.
Methods: From personal experience and a comprehensive literature search by using multiple search strategies (ASSIA and ISI Web of Knowledge databases) I sought the three key determinants triggering parental anxiety. Titles and abstracts were screened to identify quality studies to include, key themes were coded by hand, higher order themes were synthesised into three maps, and lines of arguments underlined in a final synthesis map.
Results: The three key determinants triggering parental anxiety were changing family dynamics, parental preferences and expectations, and inadequate paediatricians’ strategies for coping with parental anxiety. The search yielded 8501 papers, including 1004 potentially relevant studies. Subsequent screening excluded psychiatric studies and yielded 112 papers that met inclusion criteria. Overall I found 46% qualitative studies, 21% observational and prospective studies, 17% narrative reviews, and 16% other studies including two RCTs and two grounded-theory studies. Research took place mostly in the USA and rarely in developing countries. The three final mapped lines of arguments triggering parental anxiety were having a single child, gut feelings from previous hospital experience, pain-catastrophizing and fever-phobia.
Conclusions: Managing parental anxiety is a major and often neglected problem in a paediatric ED that needs a parent-centred approach based preferably on shared-decision making. Health-care professionals can reduce anxiety and save hospital resources by listening to parents, avoiding blaming them for coming or confounding emotions with psychopathology, reassuring them, reducing children’s pain as soon as possible, without trying to solve complex clinical problems immediately.