Discrimination Experiences and Clinician Communication Among Caregivers of Hospitalized Children

Caregiver-clinician communication is essential to pediatric health care, yet disparities exist in how clinician communication is perceived across different demographic groups. Limited pediatric studies have explored how discrimination affects caregiver-clinician communication. This study aims to describe associations between caregivers' experiences of discrimination and perceptions of clinician communication.

In this single-center, survey-based study, English- and Spanish-speaking caregivers of hospitalized children younger than age 18 years completed 2 validated tools: (1) the Discrimination in Medical Settings (DMS) tool (exposure) and (2) the Communication Assessment Tool-Teams (CAT-Teams) (outcome). Demographic data were also collected. Mean and median scores were reported for each tool, and answers were dichotomized (DMS: any reported discrimination vs none; CAT-Teams: "excellent" vs "less than excellent" communication reported). We used logistic regression models and Spearman rank coefficients to assess associations between the DMS and CAT-Teams, adjusting for participant characteristics.

Seventy caregivers completed all surveys. Forty-seven percent of participants reported experiencing discrimination in health care. Across all participants, the mean percentage of CAT-Teams items rated as "excellent" was 69% (SD, 36%). Caregivers who had experienced discrimination were more likely to report overall clinician communication as "less than excellent" (adjusted odds ratio [aOR], 3.44; 95% CI, 1.14-11.38), particularly for items reflecting patient engagement, such as involving them in decisions (aOR, 6.67; 95% CI, 2.07-25.53) and showing interest in their ideas about their child's health (aOR, 4.85; 95% CI, 1.52-17.95).

This study suggests that discrimination experiences among caregivers is associated with less than excellent caregiver-clinician communication, specifically communication behaviors around caregiver engagement.