Michael C. Sharp

A Multi-site Evaluation of Parent to Parent Programs for Parents of Children With Disabilities

This paper describes 2 approaches used to evaluate Parent to Parent mentoring programs in 5 states. Parents were assigned to either a treatment group or a waiting list comparison group. The treatment group participated in Parent to Parent for 2 months. Groups were compared on measures of coping, attitude, and progress on addressing problems. Analyses showed statistically significant positive gains for the parents in the treatment group. Changes on a measure of empowerment were not statistically significant. A qualitative study based on consumer satisfaction interviews with parents provided insight into what makes the Parent to Parent program work. The findings support the value of Parent to Parent self-help programs as one component of a family support system.

Communicating medical bad news: Parents' experiences and preferences

Parents (N = 189) of children enrolled in 15 developmental day care centers completed questionnaires that examined the experience of being told bad news and elicited preferences for physician behavior in a hypothetical situation (communicating the diagnosis of Down syndrome). Parents, in comparison with their experiences, preferred (p < 0.001) more communication of information and feelings by their physician. Their strongest preferences were for physicians to show caring (97%), to allow parents to talk (95%), and to allow parents to show their own feelings (93%). They wanted physicians to share information (90%) and to be highly confident (89%). Most parents (87%) desired parent-to-parent referral, but only a few (19%) were referred. We conclude that there is a difference between what parents experience and what they desire in physicians who communicate bad news. Physicians control the interaction and are highly confident, but parents especially value physicians who show caring and allow parents to talk and share their feelings.

Information needs and information seeking in community medical education.

Purpose To investigate information needs and information seeking in primary care practices serving as educational sites. Method The authors interviewed 15 community-based primary care physician-preceptors, once when the preceptor was working without a student and once when a student was present at the practice (in which case, the student was interviewed as well). The interview asked for questions that had arisen during the patient encounter or teaching moment that would need further investigation. A week after the interview, the authors contacted the preceptors to see whether they had pursued information to answer those questions. Results The preceptors generated fewer questions when students were present (0.42 versus 0.29 per patient). Both preceptors and students most frequently had questions pertaining to diagnoses and drug therapy. The proportion of questions pursued by the preceptors decreased when students were present (32% versus 16%). Conclusion These findings cast light on information needs and seeking in the context of community medical education. Further research is needed to explore variables such as practice size and access to appropriate Web-based information resources.

Child-health supervision for children under 2years of age: A review of its content and effectiveness

education, counseling, anticipatory guidance, and continuity of care. Herein we evaluate the existing literature for the effectiveness of these strategies in meeting these goals. The emphasis in this discussion is on the clinicianpatient interaction. The underlying assumption is that the clinicians time is a valuable commodity that should be utilized in the most efficient manner. The clinical content areas included are physical evaluation, advice on physical concerns, parenting advice, parent-child interaction, and developmental advice. The effectiveness of current standards and issues for research are discussed in each of these areas. Certain topics relevant to child-health supervisior~, such as screening for disease or the use of physician extenders, are not discussed.

Communicating bad news

The need to communicate bad news to patients and their families is common in the practice of obstetrics and gynecology. Although this is one of the most important interactions between caregivers and their patients, most physicians receive little or no formal education on the process of communicating bad news. Recipients for bad news favor being informed by a physician familiar to them, in the presence of support persons, and with provision of adequate medical information and referrals. The physician who imparts bad news should approach this communication directly and with a caring attitude, sensitive to both the informational content and emotional reaction. The objectives of this article are to review the literature regarding the process of communicating bad news and to set forth a set of general guidelines by which practitioners can communicate bad news more effectively and compassionately.

Ethical Issues in the Health Care of Children with Developmental Handicaps

Over the last several decades medical care has become considerably more complex. As our understanding of medical problems and their treatment has expanded, we are faced with multiple diagnostic and therapeutic options that demand consideration and decision. Within this maze of technical choices are many issues that involve the personal values of both the patient and the health professional. The moral value systems of the patient and the health professional will come into conflict at times. Not infrequently, the values of society as expressed in laws and the policies of public agencies will also come into conflict with those of the patient and health professional. Medical ethics is the discipline that examines moral values and studies these value conflicts within the health care setting.