Importance Children of marginalized racial groups have poorer surgical outcomes compared to White children. Clinical communication may contribute to these disparities.

Objective We explore racial differences in parent-clinician communication during initial consultations for elective surgical procedures in children.

Design Cross-sectional study of communication during consultations between surgical clinicians and parents of children (age 2-17) referred for initial evaluation for tonsillectomy/adenoidectomy, hernia repair, and circumcision between 2016 and 2023.

Setting Academically affiliated outpatient clinics in the Baltimore, Maryland region. Participants: Parent-clinician dyads including 22 surgical clinicians and 153 parents.

Main Outcome(s) and Measure(s) Visits were audio-recorded and coded using the Roter Interaction Analysis System. Outcomes included visit-level measures (parent versus clinician verbal dominance and patient-centeredness ratio), clinician communication (facilitation/activation statements to encourage parent participation, emotional statements, social chit-chat, and positive affect), and parent communication (emotional statements, social chit-chat, positive affect). We used generalized estimating equations to test associations of parent race with visit communication, accounting for nesting of visits within clinicians and adjusting for parent sociodemographic variables.

Results Of the 142 parents, 57 (40%) were Black and 85 (60%) were White. Of the 22 clinicians, 14 were White and 8 reported other or multiple ethnicities. In unadjusted models, visits with Black parents had higher clinician verbal dominance but no difference in overall patient-centeredness scores relative to visits with White parents. However, visits with Black parents had fewer clinician chit-chat statements, fewer total parent statements, fewer parent emotional statements, fewer parent chit-chat statements, and lower parent positive affect. After adjusting for parent sociodemographic variables, clinician verbal dominance remained significantly higher, with clinicians making 0.39 more statements per parent statement (95% CI: 0.08 to 0.70).

Conclusions and Relevance Parent race was associated with differences in clinician, parent, and interactive visit communication, although some differences appear to be mediated by sociodemographic factors. Parents’ non-racial sociodemographic factors did not appear to explain why verbal dominance was higher during visits with Black parents. Application of patient-centered communication and engagement strategies may help to bridge social distance in pediatric surgical care.

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

Findings Consultations with Black parents had higher clinician verbal dominance, less parent emotional expression, and less social chit-chat (both parent and clinician) relative to visits with White parents.

Meaning Our findings reveal 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.

The authors have declared no competing interest.

This study was funded by NHLBI (R01HL166504, PI: Emily Boss). Chenery Lowe is supported by a training grant from NHGRI (T32HG008953).

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB OF Johns Hopkins School of Medicine gave ethical approval for this work (IRB00259996).

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