Parent-Engaged Development of the Emergency Pediatric Inclusive Communication Framework

Implicit racial biases are well documented in the pediatric emergency department (ED). Physician communication may be a modifiable behavior through which biases contribute to health disparities. We aimed to establish expert consensus regarding the ways in which physician communication is likely to be influenced by racial bias and lead to inequity in the pediatric ED.

We used a modified Delphi approach to establish consensus among a panel of experts (parents of pediatric ED patients of color [n = 3], physicians and researchers with relevant expertise [n = 10]). The consensus process involved two rounds of moderated panel discussion followed by an online questionnaire. Assessed physician behaviors were generated from the panel discussions and from our prior qualitative research with physicians and parents from the pediatric ED. Panelists used 5-point Likert scales to rank the likelihood that physician behaviors were racially biased and the extent to which this contributed to inequity.

Of 49 assessed physician behaviors, 28 met consensus as likely to be racially biased, including 12 assumptions that inform physician communication (assumptions about parent social capacity, parent emotions, and the physician's role in the parent-physician interaction) and 16 communication behaviors (empathic communication, listening, information sharing, and engagement in decisions).

Guided by communication accommodation theory and patient-centered communication, our findings support a conceptual framework demonstrating pathways through which implicit racial biases lead to child health inequity. This research creates a foundation for subsequent efforts aimed at identifying and mitigating the effects of implicit racial bias in the ED.