Project CONNECTS (Communication and Outcomes that eNhaNce Equity in Childhood Tonsillectomy and Sleep)

项目 CONNECTS（增强儿童扁桃体切除术和睡眠公平性的沟通和成果）

• 批准号: 10565822
• 负责人: Emily Frances Boss
• 金额: $ 60.67万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-05 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10565822
• 关键词: Address; Adenoidectomy; Affect; Attitude; Audiotape; Behavior; Black race; Caring; Child; Child Care; Child Rearing; Childhood; Clinical; Code; Collaborations; Communication; Communication Research; Complex; Consultations; Coupled; Decision Making; Disparate; Disparity; Educational Intervention; Elements; Emotional; Emotions; Environmental Risk Factor; Equity; Ethnic Origin; Family; Goals; Hispanic; Institution; Intervention; Interview; Language; Learning; Low income; Maps; Mediating; Mediator; Minority; Operative Surgical Procedures; Outcome; Parents; Participant; Patient-Focused Outcomes; Patients; Perception; Persons; Play; Population; Postoperative Period; Prevalence; Procedures; Published Comment; Quality of Care; Race; Reaction; Recording of previous events; Reduce health disparities; Regrets; Reporting; Research; Role; Sleep; Sleep Apnea Syndromes; Sleep disturbances; Snoring; Sum; Surgeon; Surgical complication; Testing; Time; Tonsillectomy; Trust; Visit; Vulnerable Populations; Work; alternative treatment; care delivery; care outcomes; clinical encounter; cohort; communication behavior; cultural competence; disparity reduction; ethnic bias; ethnic diversity; ethnic minority population; experience; health care quality; implicit bias; improved; improved outcome; innovation; insight; minority children; patient oriented; physical conditioning; poor sleep; preference; racial bias; racial diversity; racial minority population; recruit; repository; response; shared decision making; social; surgery outcome; therapy development

PROJECT SUMMARY/ABSTRACT We evaluate the influence of patient race/ethnicity and surgeon bias on communication and outcomes for children with obstructive sleep-disordered breathing (OSDB). OSDB occurs in up to 20% of children and impacts physical health, behavior, and learning. The primary treatment is tonsillectomy, with or without adenoidectomy, which is the most common major surgical procedure performed in U.S. children. Children who are Black or Hispanic have increased prevalence of OSDB, poorer sleep outcomes, and more complications of surgery. Clinician implicit bias may be an important contributor to these disparities, as evolving evidence shows that bias negatively impacts patient relationships, care delivery, and outcomes for vulnerable populations. We have previously shown that surgeons inconsistently offer alternatives to surgery and rarely elicit family preferences when speaking to parents, and that they are less likely to explore emotions of minority families. These findings, coupled with known disparities in OSDB clinical outcomes, highlight the critical problem that surgeon implicit attitudes toward minority families may influence communication, decision-making, and ultimately outcomes for children with OSDB. Our long-term goal is to improve equity, healthcare quality, and outcomes for children with OSDB. The overall objective of this application is to develop a comprehensive profile of the complex social and interpersonal dynamics that may affect treatment decisions and cause disparate patient outcomes for minority children. To do so, we will establish across three institutions a repository of audio-recorded encounters between a large, diverse cohort of surgical clinicians and parents of children undergoing OSDB consultations. We will first evaluate the influence of clinician implicit bias and patient race/ethnicity on surgeon parent-communication and quality and equity of OSDB care. We will quantitatively code communication behaviors (patient-centeredness, emotional responsiveness, and shared decision-making) of parents and clinicians occurring during child OSDB consultations and test for differences between high and low implicit bias clinicians, by patient race and ethnicity. We will also examine differences in parent trust in clinician, decision regret, and clinical outcomes, and assess whether communication behaviors mediate observed disparities in these patients and parent reported OSDB outcomes. We will then interview a subset of Black, Hispanic, and White parents and high and low bias clinicians to understand the potential influence of race, ethnicity, and bias on communication, and learn patient-centered solutions to improve communication. Using a stimulated recall qualitative approach, participants listen to audiotapes of their own clinical encounters and directly comment on salient elements of communication that occurred. Findings from this research will directly inform development of interventions to mitigate surgeon bias, promote culturally competent communication, and improve outcomes for children with OSDB.

项目摘要/摘要 我们评估了患者种族/民族和外科医生偏见对沟通和预后的影响 儿童阻塞性睡眠呼吸障碍(OSDB)。高达20%的儿童会发生强迫症， 影响身体健康、行为和学习。主要的治疗方法是扁桃体切除术，不管有没有 腺样体切除术，这是美国儿童最常见的主要外科手术。儿童 谁是黑人或西班牙裔，OSDB的患病率更高，睡眠结果更差，等等 手术并发症。临床医生的内隐偏见可能是造成这些差异的一个重要因素，因为 不断发展的证据表明，偏见对患者关系、护理提供和预后都有负面影响 弱势群体。我们之前已经表明，外科医生不一致地提供手术的替代方案。 在与父母交谈时，他们很少引起家人的偏好，而且他们不太可能探索情感 少数族裔家庭。这些发现，再加上OSDB临床结果的已知差异，突显了 外科医生对少数族裔家庭的含蓄态度可能影响沟通的关键问题， 决策，以及OSDB儿童的最终结果。我们的长期目标是改善公平， OSDB儿童的医疗质量和结果。这个应用程序的总体目标是开发 对可能影响治疗决策的复杂社会和人际动态的全面描述 并对少数族裔儿童造成不同的患者结局。要做到这一点，我们将建立三个机构 一大群不同的外科临床医生和父母之间的录音会面的资料库 接受OSDB咨询的儿童。我们将首先评估临床医生内隐偏见的影响和 患者种族/种族对外科医生父母沟通以及OSDB护理质量和公平性的影响。我们会 量化编码沟通行为(以患者为中心、情感反应和分享 父母和临床医生在儿童OSDB会诊期间发生的决策)，并测试差异 根据患者种族和民族，在高和低内隐偏倚临床医生之间的差异。我们还将检查差异 父母对临床医生、决策后悔和临床结果的信任，并评估沟通是否 行为调节了观察到的这些患者的差异，父母报告了OSDB的结果。到时候我们会的 采访黑人、西班牙裔和白人父母的子集以及高低偏见的临床医生，以了解 种族、民族和偏见对沟通的潜在影响，并了解以患者为中心的解决方案 加强沟通。使用刺激回忆定性方法，参与者听录音带 他们自己的临床接触，并直接评论所发生的交流的显著要素。 这项研究的发现将直接为制定干预措施提供信息，以减轻外科医生的偏见，促进 具有文化能力的沟通，改善OSDB儿童的预后。