Project CONNECTS: Communication and Outcomes that eNhaNce Engagement in Childhood Tonsillectomy and Sleep

PROJECT SUMMARY/ABSTRACT
We evaluate the influence of patient social factors and surgeon attitudes 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. Some
groups of children have increased prevalence of OSDB, poorer sleep outcomes, and more
complications of surgery. Clinician implicit attitudes may be an important contributor to
these differences, as evolving evidence shows that communication impacts patient
relationships, care delivery, and outcomes. 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 some families
unexplained by clinical scenario. These findings, coupled with known differences in OSDB
health outcomes, highlight the critical problem that surgeon implicit attitudes may influence
communication, decision-making, and outcomes for children with OSDB. Our long-term
goal is to improve resource use, 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
differences in child health outcomes. To do so, we will establish across three institutions
a repository of audio-recorded encounters between a large, heterogeneous cohort of
surgical clinicians and parents of children undergoing OSDB consultations. We will
evaluate the influence of clinician implicit attitudes and patient social factors on surgeon
parent-communication, parent engagement, and quality and use 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 across clinician implicit attitudes, by
patient social factors. We will also examine differences in parent trust in clinician, decision
regret, and clinical outcomes, and assess whether communication behaviors mediate
observed differences in these parent-reported and clinical OSDB outcomes. We will then
interview a subset of parents and clinicians to understand the potential influence of patient
social factors and clinician attitudes on communication and learn patient-centered
solutions to improve communication and parent engagement. 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 attitudes,
promote patient-centered communication and engagement, reduce surgical overuse, and
improve outcomes for children with OSDB.

Grant Number: 5R01HL166504-04
NIH Institute/Center: NIH
Principal Investigator: Emily Boss