Patient-clinician communication in longitudinal care settings about adverse childhood experiences (ACEs) and adult traumas: A systematic review of reviews.

Abstract

Synthesize the literature on strategies for clinician communication or relationship-building during longitudinal care visits with adult patients who have had adverse childhood experiences (ACEs) and/or other traumas later in life. Systematic searches of literature reviews from 2012 to 2022 using CINAHL, PubMed, Cochrane Database, and Web of Science and Sociological Abstracts. Search terms reflected three key concepts: 1) Trauma (i.e., trauma, interpersonal violence, adverse childhood experiences), 2) Patient-provider communication/relationship-building (i.e., communication), and 3) Longitudinal patient care (primary care). Three researchers independently reviewed each title, abstract, and article to determine relevance and completed methodological quality appraisal using the AMSTAR-2 framework. Thematic analysis was used to identify key learning points and gaps in the literature. We screened 1158 articles and included 39 manuscripts: 15 % (n = 6) of the manuscripts discussed ACEs, 49 % (n = 19) discussed adult traumas, and 36 % (n = 14) discussed trauma-informed care (TIC) approaches with both or no age determination of exposure to trauma. Themes related to the role of screening, strategies to optimize communication, the importance of resources and institutional support, and associated health outcomes. According to the AMSTAR-2, most of the studies had low or critically low methodological quality. Communication with clinicians about traumatic experiences shows potential benefit to adult primary care patients. Future research rigorously evaluating training on and implementation of best practices in trauma communication is needed. Clinician- and systems-level readiness to respond to and engage in conversations about traumatic experiences with adult primary care patients requires organizational support, including sustained intervention efforts, trauma communication training, and resource allocation.