P2.294: Exploring patient centered communication dynamics in pediatric primary care messages

Purpose/Objectives: Secure messaging via electronic health records improves access to care for underserved pediatric patients. In adult oncology, patient-centered communication principles are less commonly observed in secure messaging interactions than in-person interactions, negatively impacting patient satisfaction and treatment adherence. Less is known about pediatric settings. This study examines reasons for patient-initiated secure messaging in pediatric primary care and explores how clinicians apply patient-centered communication in these interactions.

Design/Methods: We analyzed a random 10% sample (n=402) of patient-initiated secure messaging threads (patient or proxy-initiated message and all subsequent messages in thread) from a large academic pediatric primary care practice from Jan-Dec 2023. Quantitative analysis was conducted to assess the reasons for patient-initiated messages and clinician response times. For qualitative analysis, a mixed deductive-inductive approach was used to develop a codebook. Patient centered communication was defined using Epstein and Street’s framework for cancer care including information exchange and emotional responsiveness. The NURS (Name, Understand, Respect, Support) framework was applied to assess how clinicians responded to expressed patient emotion. Ten percent of message threads (n=40) were coded independently by two coders with 92% agreement and adjudication of discrepancies. Content and thematic analysis were used to analyze final codes.

Results: The patient sample was predominantly Black, English-speaking, and metro-based. On average, message threads contained 3.4 messages and time to clinician response was 15.7 hours, with most responses coming from nurse triage staff (59%). The most common reasons for patient-initiated messages were to acquire general medical advice (30%), request completion of a form or school excuse (21%), or request a new prescription or prescription refill (16%). Most clinician responses contained some patient centered communication elements, primarily information giving (Table 2). Clinicians asked questions infrequently; when clinicians did ask questions, they were mostly closed-ended, clarifying logistics. In a quarter of secure messages, the patients expressed a emotion. For most of these expressions, clinicians acknowledged patient emotions and experiences, primarily through understanding statements. Naming emotions, supporting and respecting statements were less frequently observed.

Conclusion/Discussion: Patient centered communication in secure message is present but primarily focused on information-giving. Limited use of open-ended questions and emotional acknowledgement may reflect a fundamental difference in manifestation of patient centered communication between synchronous and asynchronous patient-clinician communication. Clinicians may benefit from training on effective written communication with patients alongside verbal communication training.