381 - Pediatric Emergency Medicine Physicians' Knowledge, Attitudes, and Behaviors Regarding Adolescent Confidentiality
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 381 Publication Number: 381.212
Colleen K. Gutman, University of Florida College of Medicine, Gainesville, FL, United States; Atsuko Koyama, University Arizona College of Medicine, Phoenix, AZ, United States; Michelle L. Pickett, Medical College of Wisconsin, Milwaukee, WI, United States; Sara Holmstrom, Hasbro Children's Hospital at Rhode Island Hospital, Providence, RI, United States; Fahd A. Ahmad, Washington University in St. Louis, St. Louis, MO, United States; Ariel Hoch, Boston University School of Medicine, Boston, MA, United States; Elizabeth Lehto, Norton Children’s Medical Group affiliated with the University of Louisville School of Medicine, Louisville, KY, United States; Kari Schneider, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Kristin S. Stukus, Nationwide Children's Hospital, Columbus, OH, United States; Emily Weber, Health and Hospitals Coney Island Hospital, Brooklyn, NY, United States; Cassandra Stich, University of Florida College of Medicine, Gainesville, FL, United States; Lauren S. Chernick, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
Assistant Professor University of Florida College of Medicine Gainesville, Florida, United States
Background: Over 17 million adolescents frequent emergency departments each year. Defining best practices in confidential adolescent emergency care is an identified priority for pediatric emergency research. Objective: To describe the knowledge, attitudes, and behaviors related to confidential adolescent care among pediatric emergency department (PED) physicians. Design/Methods: We conducted a cross-sectional survey of U.S. physician members of the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) survey listserv (n = 476). Five PED physicians with expertise in adolescent health designed the survey. We adapted items from previous studies assessing confidential adolescent care. We iteratively reviewed and revised the survey with feedback from nine other PEM physicians with adolescent expertise and ten members of the PEM CRC Survey Subcommittee. The final 24 item questionnaire had three parts: 1) knowledge of adolescent confidentiality laws in the physician’s state, 2) attitudes towards providing confidential care, and 3) self-reported confidential care behaviors. Knowledge was assessed through self-reported familiarity with state laws. Attitudes and behaviors were assessed directly and through two hypothetical clinical scenarios. We dichotomized Likert responses and used chi square to compare subgroups.
Results: Characteristics of respondents are in Table 1. Respondents had higher familiarity with state laws for sexual health compared to mental health topics (defined as selecting moderately or extremely familiar for all laws within that category, 64% vs 49%, p< 0.001, Figure 1). The median age at which participants thought it was important to routinely provide confidential care was 12 years. Most respondents (95%) felt comfortable interviewing adolescents confidentially. Attitudes and behaviors regarding confidential care varied based on the hypothetical clinical scenarios (Table 2). Fewer than 25% reported always discussing sexual or mental health confidentially with adolescents during PED visits. Factors that influenced the decision to provide confidential care included chief complaint (97%), time (43%), language barriers (24%), presence of family (23%) or friends (14%), and space (22%).
Conclusion(s): PED physicians reported moderate familiarity of adolescent confidentiality laws. Physicians viewed confidential care as something they were comfortable providing yet the likelihood of doing so was low. Future efforts are needed to enhance physician knowledge of adolescent legal rights to confidentiality and to develop strategies that augment confidential care for adolescents in the PED.
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