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.

项目概要 与白人或白人以上儿童相比，接受手术的少数族裔儿童的临床结果较差 尽管临床和环境决定因素导致了这些差异，但有证据表明。 表明这些差异可能部分源于人际关系和沟通方面的种族/民族差异 外科主管和父母之间的分歧，这是医疗保健不平等的一个潜在的可补救的根源。 医生与家人沟通的重要性在儿科外科护理环境中尤为重要， 患者和家长可能认为外科医生相对于其他人来说是令人生畏的、家长式的或不屑一顾的 我们项目的目标是开发一种创新、有效且可扩展的测量和分析方法。 更好地理解患者与医生互动的方法。研究结果将为开发提供信息。 改善沟通的干预措施，从而提高儿科外科护理服务的公平质量。 该提案重点关注沟通的两个创新特征：语言风格匹配（LSM）和语言 LSM 是参与者使用共同词汇和言语结构的倾向，而 语言适应是对话参与者根据情况调整语言的过程 LSM 和语言适应都很少被探讨。 是减少社会/文化距离可以带来更高质量关系的潜在机制 使用混合方法序贯解释性研究设计，我们应用计算机化文本分析。 小儿手术期间临床医生与家长互动的工具和后续主题内容分析 咨询的目的是 (1) 阐明家长和临床医生语言风格的各个方面，并制定新的衡量标准 LSM 和儿科外科护理中的语言适应，(2) 评估收敛和预测有效性 LSM 和语言适应，以及 (3) 从临床医生访问中探索对话示例和主题 语言风格维度与家长对手术优越的评价的高低相关。 我们运用定量和定性方法来全面了解其重要性和潜力 我们建议 LSM 和语言适应对于弥合沟通中的社会距离的贡献。 与传统的手动编码相比，通过自动文本分析生成沟通措施。 创新方法可以阐明外科队长更有效沟通的机制 并减少手术结果中的种族/民族差异，为新颖的沟通提供初步有效性证据 分析方法，扩大医生沟通分析研究的成本效益和规模 家长互动，并为外科上级人员开发实时反馈系统提供信息，以提高他们的能力 随着时间的推移，每个外科临床医生都会看到很多病人，圣人的病情也会有微小的改善。 人际关系和沟通技巧对提高患者治疗结果的质量和公平性有很大影响。