Provision of Adolescent Confidential Care in a Pediatric Tertiary Care Hospital.

Abstract

Purpose: Adolescents are more likely to disclose sensitive health information if confidentiality is assured. We sought to evaluate the frequency, quality, and factors associated with provision of confidential care to adolescent patients at a pediatric teaching hospital.

Methods: We undertook a cross-sectional survey of adolescents presenting to a tertiary pediatric hospital from January 2019 to January 2020. A convenience sample of adolescents eligible for confidential care under Quebec legislation (aged 14-18 years) were surveyed either following their emergency department (ED) or inpatient care. Participants completed a self-administered electronic questionnaire regarding the confidential care provided at their initial ED or inpatient medical encounter. Multivariable logistic regression was used to identify factors associated with the provision of confidential care.

Results: Overall, 406 adolescents completed the survey (335 ED; 71 inpatient); 137 (33.7%) endorsed being offered and 95 (69%) accepted confidential time. Among adolescents receiving confidential care, 43% reported that the limits of confidentiality were reviewed and 23% reported that private issues were still discussed in front of family members. Multivariable analysis revealed inpatient setting (adjusted odds ratio [aOR] 2.28, 1.04-5.01), female gender (aOR 2.02, 1.21-3.38), age (aOR 1.67, 1.03-2.69), psychiatric diagnosis (aOR 8.10, 1.47-44.6), resident involvement (aOR 1.96, I.09-3.53) were all positively associated with the provision of confidential care.

Discussion: Survey results suggest inadequate provision of confidential care in an academic pediatric hospital. The limits of confidentiality were not consistently explained, and breaches in confidentiality were not infrequent. Confidentiality-specific education initiatives are necessary to improve the frequency and quality of confidential care for adolescents in tertiary care settings.