Pruebas piloto de una intervención de comunicación informada sobre equidad y trauma para rondas centradas en la...

Robust evidence has demonstrated racial and language-based inequities in clinician communication. We developed a communication coaching intervention to teach clinician educators and their learners communication skills for family-centered rounds in areas where racial inequities have been documented.

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 five domains: (1) trauma- informed care, (2) respect (3) affirmation (4) interpreter support, and (5) engaging caregivers. Clinicians completed the Feasibility of Intervention Measure (FIM) and Acceptability of Intervention Measure (AIM) as well as a brief interview post-intervention. We audio-recorded rounds with Black or Latino(a/e) caregivers pre-and post-intervention in both arms; caregivers completed a post-rounds survey. Coders 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=0.001) and partnership-building statements (p=0.006) and interrupted caregivers less (p=0.04) after receiving the intervention compared to before. Further, coders rated these encounters as having higher respect (p=0.04). Caregivers post-intervention reported greater trust (p=0.02), shared decision-making (p=0.04), and feeling that their concerns were fully elicited (p=0.04) compared to the pre-intervention encounters.

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