Parent-Engaged Development of the Emergency Pediatric Inclusive Communication Framework.

Area of Science:

• Health Equity
• Medical Communication
• Implicit Bias Research

Background:

• Implicit racial biases are prevalent in pediatric emergency departments (EDs).
• Physician communication is a potential pathway for these biases to create health disparities.
• Understanding these communication dynamics is crucial for addressing inequities.

Purpose of the Study:

• To achieve expert consensus on how physician communication in the pediatric ED is influenced by racial bias.
• To identify specific physician communication behaviors and assumptions that lead to inequity.
• To develop a framework for understanding the link between implicit bias and child health inequity.

Main Methods:

• A modified Delphi approach was used with a panel of experts, including parents of pediatric ED patients of color and medical professionals.
• Consensus was built through moderated panel discussions and an online questionnaire.
• Physician behaviors were assessed using 5-point Likert scales to determine the likelihood of racial bias and contribution to inequity.

Main Results:

• Consensus was reached on 28 out of 49 assessed physician behaviors as likely racially biased.
• This included 12 assumptions (e.g., about parent capacity, emotions) and 16 communication behaviors (e.g., empathic communication, information sharing).
• These identified behaviors and assumptions directly impact parent-physician interactions and decision-making.

Conclusions:

• Implicit racial biases manifest in physician communication, creating pathways to child health inequity in the pediatric ED.
• Findings support a conceptual framework linking biased communication to health disparities, guided by communication accommodation and patient-centered theories.
• This research provides a foundation for interventions to mitigate the impact of implicit bias in healthcare settings.