Influence of multi-party consultations on child involvement in clinical encounters: An observational study of paediatric palliative care

Objective: To investigate how the presence of multiple parties during paediatric palliative care encounters influences involvement of child patients. 

Methods: This mixed-methods observational study analysed 60 video recorded routine clinical encounters within three paediatric palliative care services in Australia. These were classified using a coding scheme that was iteratively developed using conversation analysis methods. Coded data were analysed statistically, with qualitative conversation analysis methods used to explore statistical findings. 

Results: Statistical analysis of coded data indicated that child involvement increased when more adults were present during an encounter. The number and role of adults present were associated with child involvement. Clinicians were most involved with child patients when there were at least two clinicians present. Clinician involvement with child patients peaked when multiple clinicians were present and when there was only one adult family member present. When multiple family members were present, the likelihood that children would respond to attempts by adults to involve them increased. 

Conclusions: Including multiple clinicians and family members in paediatric palliative care encounters is associated with increased involvement of child patients. Practice implications: To foster optimal conditions for the involvement of children, multiple clinicians and – where possible – multiple family members should be present during clinical encounters.