Interacting with child patients: Analysis of video recorded paediatric palliative care consultations

The United Nations Convention on the Rights of the Child recognises children’s rights to be active participants in matters that concern them, but little is known about ways in which children with life-limiting conditions can be involved in discussions about their care. The aim of this study is to develop foundational new knowledge about the ways in which children are currently involved in paediatric palliative care consultations. To achieve this aim, 83 real-world consultations were video recorded across three paediatric palliative care services in Australia, involving 51 families and 56 clinicians. Consultations occurred in outpatient (n = 33), telehealth (n = 23), inpatient (n = 13), and home visit (n = 14) settings. Of these 83 consultations, analysis focused on 58 consultations that were attended by child patients. These were examined using conversation analysis, a leading approach to the study of communication in healthcare.

This approach involves detailed inductive analysis of recordings of real-world social interaction. Comprehensive analysis identified fourteen communication practices through which children became involved in paediatric palliative care consultations. These communication practices include greetings, farewells, questions, instructions, singing, and playing. Many of the communication practices that were identified could be used by clinicians, family members, or child patients themselves, illustrating the diverse ways interaction with children is afforded in this setting.

This new understanding of the myriad ways children can be involved in paediatric palliative care consultations provides evidence of the holistic care provided in this setting, and examples of the diverse interpersonal skills required of healthcare professionals who work in this area.