Parent Race and Communication During Elective Pediatric Surgery Consultations

Importance: 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. Objective: To explore racial differences in parent-clinician communication during initial consultations for elective surgical procedures in children and adolescents. Design, Setting, and Participants: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.