(141) Patient-Provider Relationship Quality in Teens at Risk for Substance Use

Background & Introduction: Patient-provider relationships are essential for adolescent health engagement and outcomes. Adolescents who trust their physicians are more likely to disclose sensitive information, allowing for modification of risky behaviors. Adolescent physicians may center confidentiality to promote teen disclosure and enhance opportunities for prevention measures. Limited work has investigated the youth-provider relationship in substance use (SU) prevention in primary care settings. Though caregivers are often excluded from sensitive SU discussions, parent-child connectedness and communication has been identified as a protective factor against development of adolescent SU. Adolescent primary care providers are tasked with navigating the protection of patient confidentiality while balancing the needs for caregiver involvement in the maintenance of patient-provider trust. Identification of SU in adolescent primary care can be conducted through screening, brief intervention, and referral to treatment (SBIRT), though it is unclear for physicians how the inclusion of caregivers in SBIRT will influence clinical rapport. This study evaluates whether teens at-risk for SU reported differences in patient-provider relationship quality after being randomly assigned to receive either enhanced family-based screening and brief intervention (SBIRT-F) or adolescent-only screening and brief intervention (SBIRT-A).

Methods: We examined patient-provider relationship quality among teens screened as at-risk for substance use during primary care visits at four major urban hospitals. Teen screenings were conducted using the CRAFFT, while caregivers were asked to report beliefs about their teen’s SU. Teens randomized to SBIRT-A received SU counseling without a caregiver present, while those randomized to SBIRT-Family (SBIRT-F) received SU counseling alone and again with a caregiver present. Post-intervention, all teens completed a seven-item measure assessing patient-provider relationship quality in terms of confidentiality, judgement, respect, honesty, and trust. Items were rated on a 5-point Likert scale (1=Not at all to 5 =Very much). Independent-samples t-tests with Bonferroni corrections compared total scores and item-level between-group differences in the full sample and within subgroups based on self-identified sex and race.

Results: A total of 283 teens aged 12-17 years screened as at-risk and were randomized into SBIRT-A (41%) versus SBIRT-F (58%). Participants identified as primarily female (68%), and either White (46%), Black (21%), or another race (33%). Of those who chose Other, 83% identified as Hispanic. No significant differences were observed between SBIRT-A and SBIRT-F conditions for the total patient-provider relationship quality scores or any individual scale items. No significant differences were found among sex- or race-based subgroups.

Conclusion & Discussion: Caregiver inclusion in screening and brief interventions for youth SU did not alter teens’ perceptions of patient-provider relationship quality. Findings suggest that brief interventions for youth SU, whether delivered alone or with caregivers, do not differentially affect how teens experience their relationship with their primary care provider. This remained consistent across sex- and race-based subgroups. These findings push back on concerns that involving caregivers, and openly discussing SU risks, damages clinical rapport between teens and providers. Despite provider concerns that these third rail topics may trigger stigma or undermine trust, teens in this study generally reported feeling connected, respected, and not judged—suggesting that conversations about substance use are not only possible, but well received. Results from this study support the implementation of family-based SBIRT procedures in primary care visits.

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