Child health providers' precautionary discussion of emotions during communication about results of newborn genetic screening.

OBJECTIVE To demonstrate a quantitative abstraction method for Communication Quality Assurance projects to assess physicians' communication about hidden emotions after newborn genetic screening. DESIGN Communication quality indicator analysis. SETTING Standardized parent encounters performed in practicing physicians' clinics or during educational workshops for residents. PARTICIPANTS Fifty-nine pediatrics residents, 53 pediatricians, and 31 family physicians. INTERVENTION Participants were asked to counsel standardized parents about a screening result; counseling was recorded, transcribed, and parsed into statements (each with 1 subject and 1 predicate). Pairs of abstractors independently compared statements with a data dictionary containing explicit-criteria definitions. OUTCOME MEASURES Four groups of "precautionary empathy" behaviors (assessment of emotion, anticipation/validation of emotion, instruction about emotion, and caution about future emotion), with definitions developed for both "definite" and "partial" instances. RESULTS Only 38 of 143 transcripts (26.6%) met definite criteria for at least 1 of the precautionary empathy behaviors. When partial criteria were counted, this number increased to 80 of 143 transcripts (55.9%). The most common type of precautionary empathy was the "instruction about emotion" behavior (eg, "don't be worried"), which may sometimes be leading or premature. CONCLUSIONS Precautionary empathy behaviors were rare in this analysis. Further study is needed, but this study should raise concerns about the quality of communication services after newborn screening.