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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.

项目总结/文摘