Joking or decision-making? Affective and instrumental behaviour in doctor-parent-child communication.

Advocating active child participation in medical encounters is in line with demands for shared decision-making and informed consent. The sparse literature on doctor-child communication, however, conceptualizes children as passive participants and depicts the stereotype of a 'joking' relationship, which is limited mainly to affective behaviour. This descriptive study explores the nature of communication in the doctor-parent-child triad at the general practitioner's surgery. Video-taped observations of 106 medical interviews were analysed in terms of affective and instrumental behaviour. An adjusted version of the Roter Interaction Analysis System (RIAS) was used to analyse the doctor-parent-child triad. The videos, taken over a period of almost twenty years, made it possible to look for the presence of effects over time. The results show that the steroeotype of doctor-child interaction as a joking relationship does not hold true. In fact, besides affective behaviour, there was more exchange of instrumental behaviour. The age of the child was positively related to child participation. Time appears to have had a rather limited effect on the child's participation. Whereas GPs accomodated their behaviour to the child's age by displaying more instrumental behaviour towards older children, the nature of parental behaviour appeard to be almost constant. The results are discussed in terms of the relevance for shared decision-making in medical consultations regarding children, and recommendations are given for medical practice and health education. (aut.ref.)