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

项目总结/摘要 我们评估了患者种族/民族和外科医生偏见对沟通和结果的影响， 儿童阻塞性睡眠呼吸障碍（OSDB）。OSDB发生在高达20%的儿童中， 影响身体健康行为和学习主要治疗是扁桃体切除术，有或没有 腺样体切除术，这是美国儿童最常见的主要外科手术。儿童 黑人或西班牙裔的OSDB患病率增加，睡眠结果更差， 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， 不断发展的证据表明，偏见会对患者关系、护理提供和治疗结果产生负面影响， 弱势群体。我们以前已经表明，外科医生不一致地提供替代手术 在与父母交谈时，他们很少能引出家庭偏好， 少数民族家庭。这些发现，加上已知的OSDB临床结局的差异，突出了 关键问题是外科医生对少数民族家庭的内隐态度可能影响沟通， 决策，并最终与OSDB儿童的结果。我们的长期目标是提高公平性， OSDB儿童的医疗质量和结局。本申请的总体目标是开发 可能影响治疗决策的复杂社会和人际动态的全面概况 并导致少数民族儿童的不同患者结果。为此，我们将建立三个机构， 一个大型的、多样化的外科临床医生和父母之间的音频记录遭遇的存储库 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， 患者种族/民族对外科医生父母沟通以及OSDB护理的质量和公平性的影响。我们将 量化编码沟通行为（以患者为中心，情绪反应，和共享 决策）的父母和临床医生发生在儿童OSDB咨询和测试的差异 高和低隐式偏见临床医生之间，由患者种族和民族。我们还将研究 在父母对临床医生的信任、决策后悔和临床结果中，并评估是否沟通 行为介导观察到的这些患者和父母报告的OSDB结果的差异。然后我们将 采访黑人、西班牙裔和白色父母以及高偏倚和低偏倚临床医生，以了解 种族、民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。使用刺激回忆定性方法，参与者听录音带， 他们自己的临床遭遇，并直接评论所发生的通信的突出元素。 这项研究的结果将直接为干预措施的发展提供信息，以减轻外科医生的偏见，促进 文化上胜任的沟通，并改善OSDB儿童的结果。

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.