• Jeanne Van Cleave, Michele Heisler, Jeffrey M Devries, Terence A Joiner, and Matthew M Davis.
• Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, 50 Staniford St, Ste 901, Boston, MA 02114, USA. jvancleave@partners.org
• Arch Pediatr Adolesc Med. 2007 Dec 1;161(12):1170-5.

ObjectivesTo compare parents of children with special health care needs (CSHCN) with other parents to determine parents' expectations and priorities for discussing concerns related to a child's acute or chronic illness at well-child care visits, the association of unmet expectations and priorities with satisfaction, and whether discussing illness displaces prevention topics.DesignWritten, self-administered survey of parents at well-child care visits.SettingTwo community-based pediatric practices in suburban southeast Michigan.ParticipantsFive hundred parents with children aged 6 months to 12 years.Main ExposureHaving a special health care need.Main Outcome MeasuresExpectations and priorities for discussing illness-related topics (chronic and acute illnesses, medications, specialist referrals, and effects of health on life overall), actual discussion regarding illness and preventive topics, and satisfaction.ResultsCompared with parents of children without chronic conditions, parents of CSHCN were more likely to expect to discuss their child's illness (81% vs 92%, respectively; P < .001); 79% of parents of CSHCN ranked illness among their top 3 priorities (vs 53% of other parents [P < .001]). Parents of CSHCN reported discussing a mean of 3.2 illness topics, as compared with a mean of 2.2 illness topics for other parents (P < .001). Having more than 1 unmet expectation for discussing illness was associated with higher odds of lower satisfaction (for parents of CSHCN: odds ratio, 7.2; 95% confidence interval, 2.9-18.3; for other parents: odds ratio, 3.0; 95% confidence interval, 1.7-5.5). Discussing more illness topics was associated with discussing more preventive topics (P < .001).ConclusionsDiscussing illness is frequently expected and highly prioritized at well-child care visits, particularly for parents of CSHCN. Unmet expectations are associated with lower satisfaction. Incorporating illness concerns at well-child care visits may improve chronic disease management.

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