Understanding Clinician-Parent Interaction to Reduce Disparities and Improve Quality of Pediatric Surgical Care

了解临床医生与家长的互动，以减少差异并提高儿科手术护理质量

• 批准号: 10593554
• 负责人: Emily Frances Boss
• 金额: $ 18.9万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-20 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10593554
• 关键词: Address; Attitude; Caring; Child; Clinical; Code; Communication; Communication Methods; Conflict (Psychology); Consultations; Development; Dimensions; Disease; Disparity; Educational process of instructing; Equipoise; Equity; Family; Family Physicians; Feedback; Funding; Generations; Goals; Human; Intervention; Language; Length of Stay; Linguistics; Manuals; Measurement; Measures; Methodology; Methods; Minor; Minority; Operative Surgical Procedures; Outcome; Parents; Participant; Patient-Focused Outcomes; Patients; Pediatric Surgical Procedures; Physicians; Postoperative Period; Process; Psychology; Recovery; Relationship-Building; Repeat Surgery; Research; Research Design; Science; Social Distance; Source; Specialist; Specificity; Speech; Structure; Surgeon; Surgical complication; System; Text; Time; Training Programs; Transcript; Translations; Visit; Vocabulary; analytical method; automated text message; care delivery; communication behavior; computerized; cost; cost effectiveness; cultural competence; design; disparity reduction; distrust; ethnic difference; ethnic disparity; ethnic minority; experience; health care disparity; improved; innovation; minority children; minority patient; mortality; multidisciplinary; novel; patient-clinician communication; pediatric health outcomes; peer; poor health outcome; programs; provider communication; racial difference; racial disparity; racial minority; readmission rates; shared decision making; skills; skills training; social; surgery outcome; therapy development; tool

PROJECT SUMMARY Racial/ethnic minority children who undergo surgery have worse clinical outcomes compared to white or more affluent peers. Although clinical and environmental determinants contribute to these disparities, evidence suggests that these disparities may rise in part from racial/ethnic differences in relationships and communication between surgical clinicians and parents, which are a potentially remediable source of healthcare inequities. The importance of physician-family communication is particularly significant in the milieu of pediatric surgical care, where patients and parents may perceive surgeons as intimidating, paternalistic, or dismissive relative to other specialists. The goal of our project is to develop an innovative, valid, and scalable measurement and analytic approaches for better understanding of patient-physician interactions. Findings will inform development of interventions to improve communication and thereby enhance quality of equity of pediatric surgical care delivery. This proposal focuses on two innovative features of communication: linguistic style matching (LSM) and linguistic accommodation. LSM is the tendency of participants to use a common vocabulary and speech structure, while linguistic accommodation is the process by which participants in a conversation adjust their language according to the speech style of the other participant. Both LSM and linguistic accommodation have been rarely explored and are potential mechanisms by which less social/cultural distance can result in higher quality relationships and outcomes. Using a mixed-methods sequential explanatory study design, we apply computerized text analysis tools and subsequent thematic content analysis of clinician-parent interactions during pediatric surgical consultations to (1) Elucidate dimensions of parent and clinician linguistic style and generate novel measures of LSM and linguistic accommodation in pediatric surgical care, (2) Evaluate the convergent and predictive validity of LSM and linguistic accommodation, and (3) Explore dialogue examples and themes from visits where clinician linguistic style dimensions are associated with higher and lower parent ratings of surgical clinicians. We apply quantitative and qualitative methodology to wholly understand the significance and potential contribution of LSM and linguistic accommodation to bridging social distance in communication. We propose generating communication measures through automated text analysis versus traditional manual coding. Theis innovative approach can elucidate mechanisms by which surgical clinicians can communicate more effectively and reduce racial/ethnic disparities in surgical outcomes, provide initial validity evidence for novel communication analytic methods, expand the cost-effectiveness and scale of communication analysis studies of physician- parent interaction, and inform development of real-time feedback systems for surgical clinicians to improve their interactions over time. Because each surgical clinician sees many patients, small improvements in clinicians’ relationship and communication skills can have a large effect on improving quality and equity in patient outcomes.

项目摘要 接受手术的种族/族裔少数民族儿童的临床结果较差 情感同伴。尽管临床和环境决定者有助于这些差异，但证据 表明这些差异可能部分源于人际关系和交流中的种族/种族差异 在手术临床医生和父母之间，这是医疗保健不平等的潜在补救来源。 身体家庭沟通的重要性在小儿外科护理环境中尤为重要， 患者和父母可以将外科医生视为恐吓，家长式或不屑一顾的地方 专家。我们项目的目的是开发一种创新，有效和可扩展的测量和分析 方法以更好地理解患者 - 物理学家的相互作用。调查结果将为发展提供信息 改善沟通的干预措施，从而提高小儿手术护理交付的平等质量。 该提案重点介绍了交流的两个创新特征：语言风格匹配（LSM）和语言 住宿。 LSM是参与者使用通用词汇和语音结构的趋势，而 语言住宿是对话参与者根据语言调整语言的过程 对其他参与者的言语风格。 LSM和语言住宿都很少探索 并且是潜在的机制，通过这种机制，较少的社会/文化距离可以导致更高质量的关系和 结果。使用混合方法顺序挖掘研究设计，我们应用计算机文本分析 小儿手术期间临床 - 父母相互作用的工具和随后的主题内容分析 咨询（1）阐明父母和临床语言风格的维度，并生成新的测量 小儿外科护理中的LSM和语言住宿，（2）评估收敛性和预测有效性 LSM和语言住宿，以及（3）探索对话示例和临床医生的主题 语言风格维度与外科临床医生的较高和较低的父母评分有关。 我们采用定量和定性方法来完全了解重要性和潜力 LSM和语言住宿对弥合沟通中社会距离的贡献。我们建议 通过自动文本分析与传统手动编码生成通信措施。你 创新的方法可以阐明手术临床医生可以更有效沟通的机制 并减少手术结果中的种族/种族差异，为新型交流提供初始有效性证据 分析方法，扩大物理的成本效益和传播分析研究的规模 - 父母互动，并为外科临床医生的实时反馈系统开发提供信息 随着时间的推移互动。因为每个手术临床都看到许多患者，所以临床医生的较小改善 关系和沟通技巧对提高患者预后质量和股权的影响会产生很大的影响。