Adolescent, Parent and Clinician Perspectives on Time Alone in Chronic Illness Visits at a Single Children's Hospital.

BACKGROUND: Time alone between adolescents with chronic illnesses and their clinicians may contribute to patient-centred care and transition readiness within this population. Shifts in the adolescent-parent-clinician relationship underpin this contribution; as such, this qualitative study explored adolescent, parent and clinician perspectives on time alone in routine visits for paediatric chronic illness.

METHODS: Semi-structured interviews with English-speaking adolescents (ages 12-17, n = 65) and their parents (n = 63) were conducted after follow-up visits for inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), sickle cell disease (SCD) or type 1 diabetes (TID) at specialty clinics affiliated with the Children's Hospital of Philadelphia. Clinicians (n = 16) at the same clinics were also interviewed for this cross-sectional qualitative study. Interviews were transcribed, and thematic analysis was performed using an inductive approach.

RESULTS: Qualitative analysis yielded six themes: (1) Clinician, parent and adolescent factors influence provision of time alone; (2) some adolescents communicate more openly with their clinician during time alone; (3) some adolescents do not share new information during time alone; (4) time alone facilitates the development of the clinician-adolescent relationship and helps prepare the adolescent for the transition to adult care; (5) clinicians continuously re-negotiate the parent-adolescent-clinician relationship to meet adolescents' needs; and (6) time alone can raise challenges for clinicians.

CONCLUSION: Time alone can affect information sharing and relationship building between adolescents with chronic illnesses and their clinicians. By fostering open communication and trust in the adolescent-clinician relationship, time alone may help prepare adolescents with chronic illnesses for the transition to adult care.