Provider Communication Regarding Psychosocial Factors Predicts Pain Beliefs in Parent and Child

How much medical providers discuss psychosocial factors in the causes and maintenance of abdominal pain and recommend psychosocial interventions during clinic visits may also shape parent and child beliefs.

“The extent to which medical providers discuss the potential role of psychosocial factors in the causes and maintenance of abdominal pain and recommend psychosocial interventions during the clinic visit may additionally influence parent and child beliefs.18,19”

• cites [18] sourcePartly supported

  The Discussion reports that a biopsychosocial explanation of functional abdominal pain was associated with less maternal pain catastrophizing and negative affect than a biomedical explanation. But the Methods describe mothers responding to physician video vignettes, not actual clinic visits, and the study did not assess children’s beliefs or isolate the effects of recommending psychosocial interventions. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [19]Not checked — no full text of the source

Parents' beliefs about the nature and causes of somatic symptoms, and their acceptance of various treatments including psychosocial ones like cognitive behavioral therapy, play a key role in determining what treatments a child receives.

“Parental beliefs about the nature and causes of somatic symptoms and the acceptability of various forms of intervention, including psychosocial interventions such as CBT, are important in determining which treatments a child will receive.11”

• cites [11] sourcePartly supported

  The Results section reports that parents’ receptivity to medication predicted whether adolescents at high risk for ADHD used mental health services in the past year. But the paper does not establish which treatment a child receives based on parental beliefs about somatic symptoms or acceptance of CBT; the Discussion says it did not elicit parents’ explanatory models of adolescent behavior. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Lack of comfort or confidence in discussing psychosocial causes may prevent providers from initiating such discussions.

“Lack of comfort or confidence in discussing potential psychosocial causes of somatic symptoms may prevent medical providers from initiating such discussions.18,20”

• cites [18] sourceCould not verify

  The Discussion describes differences in physicians’ biomedical and biopsychosocial approaches and identifies limited clinic time as a barrier to giving a biopsychosocial explanation. Searches for provider comfort, confidence, and reluctance found no passage saying that lack of comfort or confidence prevents providers from initiating discussions of psychosocial causes. (LLM, conf=0.73)

  Experimental — accuracy not yet measured
• cites [20] sourceCould not verify

  The Communication Conduct and Discussion passages address conversations about children's illnesses and parents' perceptions of care, not providers' comfort or confidence in discussing psychosocial causes of somatic symptoms. Searches for psychosocial causes and provider reluctance found no passage addressing the proposed reason for not initiating those discussions; page numbers were not available in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Several factors, such as symptom severity and duration and past treatment experiences, are linked to parents' beliefs about the causes and treatments of various child symptoms.

“Multiple factors, including symptom severity/duration and past treatment experiences, are associated with parental beliefs about the causes of and treatments for various forms of child symptoms.11,16,17”

• cites [11] sourceCould not verify

  The Results link parental symptom ratings and medication receptivity to adolescents’ mental health service use, not symptom severity, duration, or past treatment experiences to parental beliefs about causes and treatments. The Discussion says the study did not elicit parents’ explanations of adolescent behaviors. Searches for symptom duration, past treatment experiences, and parental beliefs found no passage establishing the claimed associations. (LLM, conf=0.78)

  Experimental — accuracy not yet measured
• cites [16] sourceNot checked — no full text of the source
• cites [17] sourceNot checked — no full text of the source

Recent research supports cognitive behavioral therapy interventions that target both pain and anxiety in children with co-occurring anxiety disorders and functional gastrointestinal symptoms.

“Recent studies also provide support for CBT interventions targeting both pain and anxiety for children with comorbid anxiety disorders and functional gastrointestinal symptoms.8,9”

• cites [8] sourceSupported
• cites [9] sourceNot checked — no full text of the source

Children's beliefs about their symptoms and the acceptability of interventions matter because they can predict whether a child will receive and benefit from treatment.

“Child beliefs about the nature of their symptoms and the acceptability of interventions are also important because they may predict whether a child will receive and benefit from treatment.12,13”

• cites [12] sourceSupported
• cites [13] sourcePartly supported

  The Discussion (pp. 8–9) says mothers’ beliefs about their children’s pain may help clinicians offer acceptable treatments and may affect families’ receptiveness to referrals. The claim instead concerns children’s own beliefs, and the paper does not establish that those beliefs predict treatment receipt or benefit. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Parents in this study endorsed child anxiety symptoms and psychosocial causes of abdominal pain less frequently than previously reported.

“Parents in the present study endorsed symptoms of child anxiety and psychosocial causes of abdominal pain less frequently than previously reported.2,14”

• cites [2] sourcePartly supported

  The Discussion reports that parents of children with recurrent abdominal pain rated their children higher on anxiety measures than parents of well children, supporting this paper as a prior report of parent-endorsed anxiety symptoms. It does not report how frequently parents endorsed psychosocial causes of abdominal pain. The comparison with the citing authors’ present study is their own finding, not something this source could establish. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [14] sourceNot checked — no full text of the source

Provider communication about psychosocial causes and interventions was reported infrequently by parents, children, and providers.

“Provider communication about psychosocial causes and interventions was reported infrequently by parents, children, and providers.”

• Also stated in: § DISCUSSION · plain

  “Despite its demonstrated importance, provider communication about psychosocial causes and interventions was reported infrequently by parents, children, and providers.”

Both children and parents rated cognitive behavioral therapy as less acceptable than standard medical treatment.

“children and parents rated CBT as less acceptable than SMT”

Parents' recollection of provider communication about psychosocial causes was linked to how acceptable they found cognitive behavioral therapy.

“Parents’ recall of provider communication about psychosocial causes was associated with their own causal beliefs about pain and their perceived acceptability of CBT.”

Parents, children, and providers all reported that communication from providers about psychosocial causes and interventions occurred infrequently.

“Provider communication about psychosocial causes and interventions was reported infrequently by parents, children, and providers.”

Children's and parents' recollection of provider recommendations for psychosocial intervention was linked to how acceptable they found cognitive behavioral therapy.

“Children’s and parents’ recall of provider recommendations for psychosocial intervention was associated with their perceived acceptability of CBT.”

Parents' recollection of provider communication about psychosocial causes was linked to their own beliefs about the causes of pain.

“Parents’ recall of provider communication about psychosocial causes was associated with their own causal beliefs about pain”

Parents considered psychosocial causes of abdominal pain to be less likely than physical causes.

“Parents rated psychosocial causes for abdominal pain as less likely than physical causes”

Perceived probability of psychosocial causes was positively associated with parent-reported child anxiety severity.

“parent-reported child anxiety severity (r =.52, p <.001)”

Parents rated psychosocial causes as less likely than physical causes for the child's abdominal pain.

“In general, parents rated psychosocial causes for the child’s abdominal pain as less likely than physical causes (Inventory of Causes for Abdominal Pain [ICAP] Psychosocial Total: 4.0 ± 3.9; ICAP Physical Total: 6.0 ± 2.9; p <.001).”

Perceived probability of psychosocial causes was positively associated with non-Hispanic white race.

“Perceived probability of psychosocial causes was positively associated with non-Hispanic white race (t[55] =2.22, p =.03)”

Provider reports of communicating about psychosocial causes were significantly correlated with parent recall.

“With regard to communication about psychosocial factors that may be a cause of pain, the provider-report was significantly correlated with parent recall (r =.45, p =.002)”

• AssumptionRests on an assumption: Parent and child recall of provider communication accurately reflects what the provider communicated.

More than three-quarters of parents and children recalled that the provider recommended medication.

“In contrast, more than three-quarters of parents and children recalled the provider recommending medication (parents: 78.9%, N =45; children: 78.9%, N =30)”

Fewer than 20% of parents and children recalled that the provider recommended psychosocial intervention.

“Less than 20% of parents and children recalled the provider recommending psychosocial intervention (parents: 19.3%, N =11; children: 15.8%, N =6).”

Children's recall of provider recommendations for psychosocial intervention predicted their perceived acceptability of CBT.

“However, children’s recall of provider recommendations regarding psychosocial intervention predicted their perceived acceptability of CBT (t[8] =2.89, p =.02).”

• AssumptionRests on an assumption: Parent and child recall of provider communication accurately reflects what the provider communicated.
• AssumptionRests on an assumption: The measures used for causal beliefs and treatment acceptability validly capture those constructs.

Providers reported telling families that an FGID might cause abdominal pain in 77.3% of cases.

“Providers reported that they communicated that an FGID may be a cause of abdominal pain in 77.3% (N =34) of cases”

The association between parents' recall of provider communication about psychosocial causes and their beliefs about psychosocial causes remained significant after controlling for parent-reported anxiety severity and previous mental health visit history.

“which remained significant after controlling for parent-reported anxiety severity and history of previous mental health visit (F[1,53] =7.63, p =.01).”

The most frequently endorsed psychosocial causes by parents were nervous/worried/tense, stress, and putting too much pressure on oneself.

“The most frequently endorsed psychosocial causes were: “nervous, worried, and tense” (21.1%), “stress” (17.5%) and “putting too much pressure on himself/herself” (14.0%).”

Providers reported telling families that specific psychosocial factors might cause pain in 36.4% of cases.

“and that specific psychosocial factors may be a cause of pain in 36.4% (N =16) of cases.”

Providers judged psychosocial factors to contribute similarly to organic factors in an additional 53.5% of cases.

“However, psychosocial factors were perceived by providers to contribute to the child’s pain at a level similar to organic factors (i.e., a score between 3 and 5) in an additional 53.5% (N =23) of cases.”

Providers reported that they thought CBT was likely acceptable or effective in 53.3% of cases.

“Providers reported that they thought cognitive behavioral therapy (CBT) was likely to be acceptable/effective in treating the child’s presenting problems (i.e., a score of 6 or above on a 7-point scale) in 53.3% (N =24) of cases”

Perceived probability of psychosocial causes was positively associated with a history of at least one mental health visit for any reason.

“or for any reason (t[55] =3.68, p =.001)”

Parents' recall of provider communication about psychosocial causes predicted their beliefs about the probability of psychosocial causes.

“Parents’ recall of provider communication about psychosocial causes predicted their perceptions about the probability of psychosocial causes for pain (t[11] =2.96, p =.01)”

• AssumptionRests on an assumption: Parent and child recall of provider communication accurately reflects what the provider communicated.

Parents' perceived acceptability of CBT was positively associated with a history of at least one previous mental health visit because of abdominal pain.

“Parents’ perceived acceptability of CBT was positively associated with a history of at least 1 previous mental health visit because of abdominal pain (t[47] =4.04, p <.001)”

• AssumptionRests on an assumption: The measures used for causal beliefs and treatment acceptability validly capture those constructs.

About half of parents and children recalled that the provider said an FGID might cause abdominal pain.

“Approximately half of parents and children recalled the provider communicating that an FGID may be a cause of abdominal pain (parents: 49.1%; N =28; children: 50%, N =19) (Fig. 1).”

Parents and children rated CBT as less acceptable than SMT.

“Parents and children rated CBT (parents: 76.1 ± 20.9; children: 71.6 ± 16.5) as less acceptable than standard medical treatment (SMT) (parents: 92.8 ± 13.7; children: 87.7 ± 12.9) (ps <.001).”

• AssumptionRests on an assumption: The measures used for causal beliefs and treatment acceptability validly capture those constructs.

Perceived probability of psychosocial causes was positively associated with a history of at least one mental health visit because of abdominal pain.

“and history of at least 1 mental health visit because of abdominal pain (t[16] =2.25, p =.04)”

Parents' perceived acceptability of CBT was positively associated with living in a two-parent household.

“and living in a 2-parent household (t[54] =2.41, p =.02).”

• AssumptionRests on an assumption: The measures used for causal beliefs and treatment acceptability validly capture those constructs.

Parents' perceived acceptability of CBT was positively associated with a history of at least one previous mental health visit for any reason.

“or for any reason (t[54] =4.26, p <.001)”

• AssumptionRests on an assumption: The measures used for causal beliefs and treatment acceptability validly capture those constructs.

Parent and child recall of recommendations for psychosocial intervention and for medication were significantly correlated.

“Parent and child recall of recommendations for psychosocial intervention (r =.35, p =.03) and medication (r =.71, p <.001) were significantly correlated”

Perceived probability of psychosocial causes was negatively associated with a history of hospitalization for abdominal pain.

“and was negatively associated with history of hospitalization for abdominal pain (t[55] =2.09, p =.04).”

Only about one-fifth of parents and children recalled that the provider mentioned specific psychosocial factors as a possible cause of pain.

“However, only 19.3% (N =11) of parents and 21.1% (N =8) of children recalled the provider communicating that any specific psychosocial factors may be a cause of pain.”

Providers judged the child's pain to be entirely or almost entirely psychosocial in 30.2% of cases.

“providers reported that the pain was entirely or almost entirely psychosocial (i.e., a score of 6 or greater on a 7-point scale) in 30.2% (N =13) of cases”

Parents' recall of provider communication about psychosocial causes predicted their perceived acceptability of CBT.

“Parents’ recall of provider communication about psychosocial causes (t[28] =2.19, p =.04)”

• AssumptionRests on an assumption: Parent and child recall of provider communication accurately reflects what the provider communicated.
• AssumptionRests on an assumption: The measures used for causal beliefs and treatment acceptability validly capture those constructs.

About one-third of parents and children recalled that the provider recommended dietary changes.

“and one-third recalled the provider recommending dietary changes (parents: 33.3%, N =19; children: 34.2%, N =13).”

Parent and child recall of provider communication about psychosocial causes were not significantly correlated.

“but parent and child recall were not significantly correlated with one another (r =.25, p =.12).”

• AssumptionRests on an assumption: Parent and child recall of provider communication accurately reflects what the provider communicated.

After controlling for parent-reported anxiety severity and previous mental health visit history, the relationships between parents' recall of provider communication about psychosocial causes and recommendations for psychosocial intervention and perceived acceptability of CBT were no longer significant.

“However, these relationships were no longer significant after controlling for parent-reported anxiety severity and history of previous mental health visit.”

Parents' recall of provider recommendations for psychosocial intervention predicted their perceived acceptability of CBT.

“and parents’ recall of provider recommendations regarding psychosocial intervention (t[46] =3.69, p =.001) predicted their perceived acceptability of CBT.”

• AssumptionRests on an assumption: Parent and child recall of provider communication accurately reflects what the provider communicated.
• AssumptionRests on an assumption: The measures used for causal beliefs and treatment acceptability validly capture those constructs.

The three most frequently endorsed causes of abdominal pain by parents were physical.

“The 3 most frequently endorsed causes of abdominal pain (rated by parents as “probably yes”) were physical in nature: “stomach producing too much acid or gas” (28.1%), “constipation” (24.6%), and “sensitive or nervous stomach” (22.8%).”

The only variable associated with children's perceived acceptability of CBT was whether the child recalled that the provider recommended psychosocial intervention.

“Interestingly, the only variable associated with children’s perceived acceptability of CBT was whether the child recalled that the provider recommended psychosocial intervention.”

The association between provider communication and parents' perceived acceptability of CBT diminished after accounting for parent-reported child anxiety severity and previous mental health visit history.

“The association between provider communication and parents’ perceived acceptability of CBT diminished after accounting for parent-reported child anxiety severity and history of at least 1 previous mental health visit.”

Participants did not differ from eligible nonparticipants with regard to child gender, race, or number of previous gastroenterology clinic visits.

“Participants did not differ from those who were approached and eligible but declined participation with regard to child gender, race, or number of previous gastroenterology clinic visits.”

That prior study did not specifically assess mothers' views on cognitive behavioral therapy or other empirically supported psychological treatments for pain.

“Maternal perceptions of CBT or other empirically supported psychological interventions for pain were not specifically assessed.”

• cites [14] sourceNot checked — no full text of the source

Among those whose child's unexplained abdominal pain improved a year later, only 5% named counseling as a remedy that probably helped.

“and among those whose child’s unexplained abdominal pain had improved 1 year later, only 5% endorsed “counseling” as a remedy that probably contributed to this improvement.”

• cites [14] sourceNot checked — no full text of the source

In a sample of children with diagnosed or suspected FGID and their parents, recall of provider communication about psychosocial causes and recommendations for psychosocial intervention predicted causal beliefs and perceived acceptability of CBT.

“In a sample of children with a diagnosed or suspected abdominal pain-related functional gastrointestinal disorder (FGID) and their parents, recall of provider communication about psychosocial causes of abdominal pain and recommendations for psychosocial intervention predicted causal beliefs and perceived acceptability of cognitive behavioral therapy (CBT).”

• AssumptionRests on an assumption: Parent and child recall of provider communication accurately reflects what the provider communicated.
• AssumptionRests on an assumption: The measures used for causal beliefs and treatment acceptability validly capture those constructs.

These interventions by themselves may not be enough to effectively manage functional gastrointestinal disorders.

“However, these interventions alone may not be sufficient for effective management of FGIDs.1”

• cites [1] sourceNot checked — no full text of the source

• AssumptionRests on an assumption: Medical providers treating this population commonly offer education about functional gastrointestinal disorders, reassurance about their benign nature, dietary advice, and symptom-relief medications.

In that same study, only 18% listed counseling as a likely remedy before the medical evaluation.

“However, only 18% endorsed “counseling” as a probable remedy before the medical evaluation”

• cites [14] sourceNot checked — no full text of the source

Some study results may not generalize to gastroenterology clinics where integration between medical and mental health providers has been long established.

“Some study results may not generalize to gastroenterology clinics in which the integration between medical and mental health providers has been long established”

The intended message about psychosocial factors may not be clear to all family members, as shown by the relatively weak association between what parents and children recalled from the same clinic visit discussion.

“Although providers may believe that they are sharing information about the role of psychosocial factors for pain, the intended message may not be clear to all family members, as demonstrated in the present study by the relatively weak association between what parents and children recalled from the same clinic visit discussion.”

The study had a small sample size.

“This study has several limitations, including its small sample size.”

This study provides evidence for the importance of family-provider discussions about potential psychosocial causes of abdominal pain and psychosocial interventions.

“This study provides evidence for the importance of family-provider discussions about potential psychosocial causes of abdominal pain and psychosocial interventions”