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

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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.