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）

基本信息

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
项目类别：
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

项目摘要

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/摘要我们评估患者种族/种族和外科医生偏见对沟通和结果的影响有阻塞性睡眠呼吸的儿童（OSDB）。 OSDB最多发生在20％的儿童中影响身体健康，行为和学习。主要治疗方法是扁桃体切除术，有或没有腺样体切除术，这是在美国儿童中进行的最常见的主要手术程序。孩子们黑人或西班牙裔的人的患病率增加了，睡眠结果较差，等等手术并发症。临床医生的隐性偏见可能是造成这些差异的重要因素，因为不断发展的证据表明，偏见会对患者的关系，护理交付和结果产生负面影响脆弱的人群。我们以前已经表明，外科医生不一致地提供了手术的替代方案在与父母交谈时很少引起家庭偏好，并且他们不太可能探索情绪少数民族家庭。这些发现，以及OSDB临床结果中的已知差异，突出了外科医生对少数族裔家庭的隐性态度可能影响沟通的关键问题，决策，最终为OSDB儿童带来的结果。我们的长期目标是提高公平， OSDB儿童的医疗保健质量和结果。该应用程序的总体目的是开发复杂的社会和人际动态的全面概况，可能会影响治疗决策并为少数族裔儿童带来不同的患者预后。为此，我们将在三个机构之间建立大量，多样化的外科临床医生和父母之间的音频记录库存库接受OSDB咨询的儿童。我们将首先评估临床医生隐性偏见的影响和 OSDB护理的外科医生父母通讯以及质量和权益的患者种族/民族。我们将定量代码沟通行为（以患者为中心，情感反应能力和共享在儿童OSDB咨询期间发生的父母和临床医生的决策）测试差异通过患者种族和种族，在高和低隐式偏见临床医生之间。我们还将检查差异在父母对临床医生的信任，决策后悔和临床结果，并评估是否沟通行为介导了这些患者的观察到的差异，父母报告了OSDB结果。然后我们会采访黑人，西班牙裔和白人父母的子集以及高偏见的临床医生，以了解种族，种族和偏见对沟通的潜在影响，并学习以患者为中心的解决方案改善沟通。使用刺激的召回定性方法，参与者听听他们自己的临床遇到并直接评论发生的沟通的显着元素。这项研究的结果将直接为减轻外科医生偏见的干预措施的发展提供信息具有文化胜任的沟通，并改善OSDB儿童的成果。