Pilot Testing an Equity and Trauma-Informed Communication Intervention for Family-Centered Rounds

To evaluate the feasibility, acceptability, and preliminary efficacy of an equity-focused communication coaching intervention.

We conducted a 2-arm randomized waitlist-control trial. Attending hospitalists received the coaching intervention and were given resources to teach communication skills to trainees. We taught communication skills in 5 domains: 1) trauma-informed care, 2) respect, 3) affirmation, 4) interpreter support, and 5) engaging caregivers. Clinicians completed the Feasibility of Intervention Measure and Acceptability of Intervention Measure, as well as a brief interview postintervention. We audio-recorded rounds with Black or Latino(a/e) caregivers pre- and postintervention in both arms; caregivers completed a postrounds survey. Coders are unaware of arm-coded communication skills. We compared coded behaviors and caregiver survey responses before and after the intervention using the Wilcoxon rank sum test and regression models.

Analyses included 8 hospitalists and 43 caregivers of hospitalized children (23 in the control phase, 20 in the intervention phase). We found high clinician acceptability and feasibility ratings, with mean item scores ranging from 4.6 to 4.9 out of 5 points, respectively. In efficacy analyses, hospitalist teams used more praise (P = .001) and partnership-building statements (P = .006) and interrupted caregivers less (P = .04) after receiving the intervention compared to before. Further, coders rated these encounters as having higher respect (P = .04). Caregivers postintervention reported greater trust (P = .02), shared decision-making (P = .04), and feeling that their concerns were fully elicited (P = .04) compared to the preintervention encounters.

An equity and trauma-informed clinician communication intervention was feasible, acceptable, and showed preliminary efficacy in changing clinician behavior as well as caregiver-reported trust and communication.