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

项目摘要 与白色或更多人种相比，接受手术的种族/少数民族儿童的临床结局更差 富裕的同龄人虽然临床和环境因素有助于这些差异，证据 表明这些差异可能部分来自关系和沟通中的种族/民族差异 外科医生和父母之间的关系，这是一个潜在的医疗保健不公平的补救来源。的 医生-家庭沟通的重要性在儿科手术护理的环境中尤其重要， 患者和父母可能认为外科医生相对于其他医生是恐吓的、家长式的或不屑一顾的。 专家。我们的项目的目标是开发一个创新的，有效的，可扩展的测量和分析 更好地理解患者-医生互动的方法。调查结果将为开发 干预措施，以改善沟通，从而提高质量的公平儿科外科护理提供。 这一建议侧重于两个创新的特点，沟通：语言风格匹配（LSM）和语言 住宿. LSM是参与者使用共同词汇和言语结构的倾向， 语言顺应是会话参与者根据会话内容调整语言的过程。 另一个参与者的演讲风格。LSM和语言顺应都很少被探索 是潜在的机制，通过这种机制，更少的社会/文化距离可以产生更高质量的关系， 结果。采用混合方法序贯解释性研究设计， 工具和随后的主题内容分析的临床医生与家长的互动在儿科手术 咨询（1）阐明父母和临床医生语言风格的维度，并产生新的措施， 最小二乘法与语言调节在小儿外科护理中的应用;（2）评价收敛效度和预测效度 LSM和语言调节，以及（3）探索对话的例子和主题，从访问中，临床医生 语言风格维度与较高和较低的父母对外科临床医生的评价相关。 我们采用定量和定性的方法来全面了解其意义和潜力 最小语义距离和语言顺应在交际中对拉近社会距离的作用。我们提出 通过自动文本分析与传统的手工编码生成沟通措施。泰斯 创新方法可以阐明外科临床医生可以更有效地沟通的机制 减少手术结果中的种族/民族差异，为新的沟通提供初步有效性证据 分析方法，扩大成本效益和规模的沟通分析研究的医生- 父母互动，并为外科临床医生提供实时反馈系统的开发信息，以提高他们的 互动随着时间的推移。因为每个外科医生都要看很多病人， 人际关系和沟通技巧可以对改善患者结果的质量和公平性产生很大影响。

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.