# Parent Race and Communication During Elective Pediatric Surgery Consultations

## TL;DR

The study found that communication during pediatric surgery consultations differs by parent race, with Black parents experiencing more clinician dominance and less emotional and social interaction.

## Contribution

The study identifies racial disparities in parent-clinician communication during pediatric surgery consultations and suggests strategies to improve communication and reduce social distance.

## Key findings

- Consultations with Black parents had higher clinician verbal dominance compared to White parents.
- Black parents expressed less emotional statements and social chitchat during consultations.
- Adjusting for sociodemographic factors showed that most communication differences were due to parent behavior rather than clinician behavior.

## Abstract

This cohort study investigates the association of parent race with parent-clinician communication during pediatric elective surgery consultations.

How does parent-clinician communication differ by parent race during initial pediatric surgery consultations?

In this cohort study among 153 parents and 22 surgical clinicians, consultations with Black parents had higher clinician verbal dominance, less parent emotional expression, and less social chitchat for parents and clinicians compared with visits with White parents.

These findings suggest opportunities to mitigate racial differences in communication and bridge social distance in pediatric surgical care, including through improved clinician elicitation of patient and family concerns and intentional attempts to build rapport.

Child and adolescent members of marginalized racial groups have poorer surgical outcomes compared with White children and adolescents. Clinical communication may contribute to these disparities.

To explore racial differences in parent-clinician communication during initial consultations for elective surgical procedures in children and adolescents.

This cohort study investigated communication during consultations between parent-clinician dyads: surgical clinicians and parents of children and adolescents ages 2 to 17 years referred for initial evaluation for tonsillectomy or adenoidectomy, hernia repair, and circumcision between 2016 and 2023 at academically affiliated outpatient clinics in the Baltimore, Maryland, region.

Visits were audio-recorded and coded using the Roter Interaction Analysis System, a quantitative communication coding system developed to analyze medical interactions. Outcomes included visit-level measures (parent vs clinician verbal dominance and patient-centeredness ratio), clinician communication (facilitation and activation statements to encourage parent participation, emotional statements, social chitchat, and normalized positive affect Z scores), and parent communication (emotional statements, social chitchat, and normalized positive affect Z scores). Generalized estimating equations were used to test associations of parent race with visit communication, accounting for nesting of visits within clinicians and adjusting for parent sociodemographic variables.

A total of 153 parents (63 Black [41.2%] and 90 White [58.8%]; mean [SD] age, 35.1 [6.7] years; 135 female [88.2%]) and 22 clinicians (2 Asian [9.1%], 1 Hispanic or Latino [4.5%], 13 White [59.1%], 3 another race or ethnicity [13.6%], and 3 multiple races or ethnicities [13.6%]; 12 female [54.5%]) were included. In unadjusted models, visits with Black parents had higher clinician verbal dominance (0.4 more clinician statements [95% CI, 0.1-0.8 statements] per parent statement) but no difference in overall patient-centeredness scores compared with visits with White parents. However, visits with Black parents had 2.3 fewer clinician chitchat statements (95% CI, 3.3 to 1.3 statements), 26.6 fewer total parent statements (95% CI, 46.0 to 7.2 statements), 2.1 fewer parent emotional statements (95% CI, 3.6 to 0.7 statements), and 1.7 fewer parent chitchat statements (95% CI, 2.8 to 0.55 statements) per visit and lower parent positive affect (Z score = −0.6; 95% CI, −1.0 to −0.2) compared with visits with White parents. After adjustment for parent sociodemographic variables, clinician verbal dominance remained significantly higher, with clinicians making 0.4 more statements (95% CI, 0.1-0.7 statements) per parent statement.

In this study, parent race was associated with differences in clinician, parent, and interactive visit communication, although some differences appeared to be mediated by sociodemographic factors and most were due to differences in parent rather than clinician communication. These findings suggest that application of patient-centered communication and engagement strategies may help bridge social distance in pediatric surgical care.