Parents, kids actually agree about confidential medical care

Jonathan Klein (Photo: Jenny Fontaine)

When it comes to preventive care and confidential medical services, parents and their adolescent children actually agree with each other. They both believe that preventive care is important, that adolescents should be provided with opportunities to speak with their doctor one-on-one, and that some services should be confidential.

Parents and their children even agree, roughly, on the age at which kids should start having private conversations with a doctor — around 16 years old, or even 18 years old, many said. Doctors, however, have a different opinion. Clinical care guidelines suggest adolescents should have access to confidential screening and counseling about a variety of potentially sensitive issues much earlier in life, around age 13.

These findings are reported by University of Illinois at Chicago researchers and their colleagues in the Journal of Adolescent Health.

UIC’s Dr. Jonathan Klein led the study, which analyzed survey response data from more than 1,200 adolescents, ages 13 to 18, and their parents.

“It is encouraging to see that adolescents and their parents are, for the most part, aligned when it comes to their attitudes about preventive care, particularly on the appropriate use of confidentiality during health care visits,” said Klein, professor of pediatrics at the UIC College of Medicine. “However, this study perhaps more importantly tells us that pediatricians and family physicians need to do a better job helping parents recognize the benefits of providing adolescents with an opportunity to speak privately with their care provider long before they reach adulthood.”

The benefits most significantly include better health outcomes, Klein said, because many screening programs, especially those for reproductive health and STDs, have been proven to be more effective when adolescents are provided one-on-one time with providers.

“By encouraging young patients to speak privately with their doctors, parents help their children learn by small, incremental steps how to take ownership of their own health and they signal to their children that sensitive health-related questions are not an indicator of poor behavior or an avenue for health professionals to pass judgment,” Klein said. “They are simply and only about health.”

While the study reveals that parents and adolescents are generally in agreement, the analysis also sheds light on the issues most likely to cause disagreement.

“The largest disagreements were about what specific services should be available confidentially,” Klein said.

The survey asked adolescents and parents about 10 services and whether they should be offered to individuals under the age of 18 without parental permissions. The services were: regular health care provider appointments, STD clinic appointments, treatment for injury or assault, vaccinations, STD testing, starting a regular medication, obtaining emergency contraception, having an abortion, receiving drug or alcohol abuse counseling, and receiving inpatient treatment for drug and alcohol use.

“Not surprisingly, the services that cause the largest disagreements are those that are most debated or stigmatized in society — substance abuse counseling and reproductive care, with confidentiality about abortion services causing the most significant disagreement,” he said.

The findings showed that adolescents were almost twice as likely as their parents to think abortion services should be confidential.

“This study also showed that while most parents and adolescents agree about expectations for confidentiality, an important minority of young people who endorse confidential care have parents who do not,” Klein said.

“Therefore, health care providers should be prepared to discuss confidentiality with both their patients and adolescents’ parents, and should also advise adolescents about their legal rights to confidential care, when needed.”

Klein and his colleagues write, “For most teens, a shared understanding and better communication with parents and adolescents may be as relevant as laws, policies and clinician guidelines” when it comes to health.

Co-authors on the study, which was supported by a grant from the Merck Foundation to the American Academy of Pediatrics, are Xiaoyu Song of Mount Sinai; Hanying Yan, Dr. Marina Catallozzi, Xianling Wang, Jenifer Heitel and Dr. John Santelli of Columbia University, and Kristen Kaseeska and Julie Gorzkowski of the American Academy of Pediatrics.