Exploring Patient-to-Provider Communication of Childhood Adversity in Primary Care

Abstract

Approximately 64% of US adults have reported at least one adverse childhood experience in their lifetime. Research reveals that individuals who experience adverse events during childhood are more likely to have a greater number of health disparities in adulthood compared to adults who have not experienced traumatic events during childhood. Despite this knowledge and a growing awareness that ACEs are a significant predictor of an array of health disparities, identifying childhood adversity among adults in primary care is not a mandatory clinical assessment standard. This is largely because primary care providers are unaware of these relationships and often ill-equipped with the communication skills and training needed to elicit this clinically relevant information. Compounding this problem is that clinical communication focused on childhood adversity has not been well described in the extant literature. Thus, the purpose of this research was to better understand factors that influence how NPs communicate with adult patients about childhood adversity in the context of the primary care setting, including the use of the EHR as tool for such communication. Guided by the literature and underpinned by Carrington’s (2012) Effective Nurse-to-Nurse Communication Framework and Bandura’s (2004) Social Cognitive Theory, an emerging model of Patient-to-Provider Communication of Adverse Childhood Experiences (The PPC-ACE Model) was developed. Using the PPC-ACE Model, a qualitative descriptive study was conducted with 15 US-based primary care NPs. NPs participated in semi-structured interviews, which were recorded, transcribed verbatim, and analyzed via manual inductive thematic analysis. Data was triangulated using Atlas.ti and the Goodwin statistic. A total of 455 thematic units were abstracted from the data and organized into 31 categories and 32 subcategories. Findings from this study were all significant. Categories with the highest level of participant emphasis were Facilitators of Communication (Goodwin statistic = 0.83), Communication Approaches (Goodwin statistic = 0.78), Barriers to Communication (Goodwin statistic = 0.77), Provider Biases (Goodwin statistic = 0.73), Scope of Practice (Goodwin statistic = 0.7), Diversity in Practice Models (Goodwin statistic = 0.67), and Secondary Trauma (Goodwin statistic = 0.67). Outcomes of this study will inform future research in nursing education, nursing practice, health policy, and nursing informatics.