Factors Influencing the Conduction of Confidential Conversations with Adolescents in the Emergency Department: A Multi-Center, Qualitative Analysis

Document Type

Journal Article

Publication Date



Academic emergency medicine : official journal of the Society for Academic Emergency Medicine




BACKGROUND: Health care professionals (HCPs) in the emergency department (ED) frequently must decide whether to conduct or forego confidential conversations with adolescent patients about sensitive topics, such as those related to mental health, substance use, and sexual and reproductive health. The objective of this multi-center qualitative analysis was to identify factors that influence the conduct of confidential conversations with adolescent patients in the ED. METHODS: In this qualitative study, we conducted semi-structured interviews of ED HCPs from five academic, pediatric EDs in distinct geographic regions. We purposively sampled HCPs across gender, professional title, and professional experience. We used the Theoretical Domains Framework (TDF) to develop an interview guide to assess individual and system-level factors affecting HCP behavior regarding the conduct of confidential conversations with adolescents. Enrollment continued until we reached saturation. Interviews were recorded, transcribed, and coded by three investigators based on thematic analysis. We used the coded transcripts to collaboratively generate belief statements, which are first-person statements that reflect shared perspectives. RESULTS: We conducted 38 interviews (18 physicians, 11 registered nurses, 5 nurse practitioners and 4 physician assistants). We generated 17 belief statements across 9 TDF domains. Predominant influences on having confidential conversations included self-efficacy in speaking with adolescents alone, wanting to address sexual health complaints, maintaining patient flow, experiencing parental resistance and limited space, and having inadequate resources to address patient concerns and personal preconceptions about patients. Perspectives divided between wanting to provide focused medical care related only to their chief complaint versus self-identifying as a holistic medical HCP. CONCLUSION: The factors influencing the conduct of confidential conversations included multiple TDF domains, elucidating how numerous intersecting factors influence whether ED HCPs address sensitive adolescent health needs. These data suggest methods to enhance and facilitate confidential conversations when deemed appropriate in the care of adolescents in the ED.