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Parent Race and Communication During Elective Pediatric Surgery Consultations
Insights
Racial disparities exist in pediatric surgical consultations, with Black parents experiencing less clinician engagement and more clinician dominance. Addressing communication gaps is crucial for equitable surgical care.
Area of Science:
- Pediatric Surgery
- Health Disparities
- Clinical Communication
Background:
- Children from marginalized racial groups often face worse surgical outcomes than White children.
- Clinical communication patterns may exacerbate these racial disparities in healthcare.
Purpose of the Study:
- To investigate racial differences in parent-clinician communication during initial consultations for pediatric elective surgeries.
- To identify specific communication behaviors associated with parent race.
Main Methods:
- A cross-sectional study analyzed audio recordings of 153 parent-clinician dyads during consultations for common pediatric surgeries.
- Communication was coded using the Roter Interaction Analysis System (RIAS) to measure verbal dominance, patient-centeredness, and affective communication.
- Generalized estimating equations were used to assess the association between parent race and communication outcomes, adjusting for sociodemographic factors.
Main Results:
- Visits involving Black parents showed significantly higher clinician verbal dominance compared to visits with White parents.
- Black parents made fewer statements overall and exhibited lower positive affect during consultations.
- While some differences were mediated by sociodemographic factors, clinician dominance persisted after adjustment.
Conclusions:
- Parent race is associated with distinct patterns of communication in pediatric surgical consultations.
- Differences were observed in clinician, parent, and interactive communication, with parent communication playing a significant role.
- Implementing patient-centered communication strategies may help reduce social distance and improve equity in pediatric surgical care.
Importance:
Children of marginalized racial groups have poorer surgical outcomes compared to White children. Clinical communication may contribute to these disparities.
Objective:
We explore racial differences in parent-clinician communication during initial consultations for elective surgical procedures in children.
Design:
Cross-sectional study of communication during consultations between surgical clinicians and parents of children (age 2-17) referred for initial evaluation for tonsillectomy/adenoidectomy, hernia repair, and circumcision between 2016 and 2023.
Setting:
Academically affiliated outpatient clinics in the Baltimore, Maryland region.
Participants:
Parent-clinician dyads including 22 surgical clinicians and 153 parents.
Main Outcome(S) And Measure(S):
Visits were audio-recorded and coded using the Roter Interaction Analysis System. Outcomes included visit-level measures (parent versus clinician verbal dominance and patient-centeredness ratio), clinician communication (facilitation/activation statements to encourage parent participation, emotional statements, social chit-chat, and positive affect), and parent communication (emotional statements, social chit-chat, positive affect). We used generalized estimating equations to test associations of parent race with visit communication, accounting for nesting of visits within clinicians and adjusting for parent sociodemographic variables.
Results:
Of the 153 parents, 63 (41.2%) were Black and 90 (58.8%) were White. Of the 22 clinicians, 14 (63.6%) were White and 8 (36.4%) reported other or multiple ethnicities. In unadjusted models, visits with Black parents had higher clinician verbal dominance but no difference in overall patient-centeredness scores relative to visits with White parents. However, visits with Black parents had fewer clinician chit-chat statements, fewer total parent statements, fewer parent emotional statements, fewer parent chit-chat statements, and lower parent positive affect. After adjusting for parent sociodemographic variables, clinician verbal dominance remained significantly higher, with clinicians making 0.4 more statements per parent statement (95% CI: 0.1 to 0.7).
Conclusions And Relevance:
In this cohort study of communication during pediatric surgical consultations, parent race was associated with differences in clinician, parent, and interactive visit communication, although some differences appeared to be mediated by sociodemographic factors and most were due to differences in parent rather than clinician communication. Application of patient-centered communication and engagement strategies may help to bridge social distance in pediatric surgical care.
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