Emotional Communication Between Surgeons and Parents Observed

Grace Leu, MD

A new cross-sectional study found that emotional communication occurs between surgeons and patents of pediatric patients with obstructive sleep-disordered breathing (SDB). However, the variety of surgeon responses according to parental race and ethnicity suggested the existence of implicit biases in surgeon-patient communication, prompting investigators to call for further research to inform efforts to promote family-centered and culturally aware communication in surgery.

Though the benefits of patient-centered communication have been well studied, leafing to greater satisfaction, treatment adherence and clinical outcomes, little is known of the emotional communication between parents and surgeons.

Investigators led by Grace Leu, MD, Department of Otolaryngology at Johns Hopkins School of Medicine, Baltimore, believed that understanding the patterns and correlates of emotional communication would foster collaboration during surgical consultations.

As such, the team set out to describe the emotional expressions by parents when bringing their child for evaluation of SDB in addition to surgeon responses to these emotional expressions in an attempt to evaluate the association between parental demographic characteristics and surgeon response types.

The Methods

The team collected data from a larger study on shared decision-making in consultations for pediatric tonsillectomy.

From April 1, 2016 to May 31, 2017, parents of children aged 2-17 years who were newly evaluated for tonsillectomy at the 3 outpatient sites were identified through electronic records and contact by telephone.

Parents and surgeons were tasked with completing a baseline demographic questionnaire prior to the consultations, which were audio recorded and transcribed.

Parents received $40 as compensation for the baseline questionnaire and the audio recording of their visit. Surgeons received $250 for allowing fewer than 15 of their patients to be enrolled and audio recorded in the study.

From there, the Verona Coding Definitions of Emotional Sequences (VR-CoDES) was developed to measure emotional communication between clinicians and patients with a focus on adverse emotional expressions.

Parental expressions of unfavorable emotions were classified as either cues or concerns, the latter being defined as an “unambiguous expression of an unpleasant emotion that is explicity verbalized”. Parental cues would be further classified into 7 categories (A-G) on the basis of communication method (verbal vs. nonverbal) and language style.

Space provision indicated whether the surgeon provided an opportunity for further elaboration from a parent, and the categorization of all of the surgeon responses, detailed definitions, and examples from the transcript of the recording were also documented.

The Findings

Investigators selected 149 eligible families, with 59 parents (39.6%) agreeing to participate and to have their consultation audio recorded.

Parent participants had a mean (SD) age of 33.9 (6.4) years and were predominantly women (n = 53 [89.8%]), with 6 men (10.2%).

Regarding race and ethnicity, 1 parent (1.7%) identified as Asian, 22 parents (37.3%) as African American, 5 parents (8.5%) as Hispanic/Latino, and 30 parents (50.8%) as White individuals, and only 1 parent (1.7%) identified under the “Other” option, specifying Trinidadian.

Of the 59 consultations, 40 (67.8%) contained at least 1 emotional expression.

Investigators observed that parents made 123 distinct emotional expressions (mean [SD], 3.08 [2.29] expressions per visit), which were often expressed as subtle cues (n = 103 of 123 [83.7%]) compared to explicit concerns (n = 20 [16.3%]). Most expressions (n = 98 [79.7%]) were related to medical issues experienced by the child (eg, symptoms and surgical risks).

A majority of surgeon responses provided parents space for elaboration of emotional expressions (n = 86 [69.9%]) and were nonexplicit (n = 55 [44.7%]).

However, surgeons were less likely to explore the emotions of parents from racial and ethnic minority groups compared with White parents (OR, 0.47; 95% CI, 0.18-0.98).

“These findings highlight the need for increased awareness of the implicit biases in surgeon-patient communication and call for further research to inform efforts to promote family-centered, culturally competent communication in surgery,” the team wrote.

The study, "Parental Expression of Emotions and Surgeon Responses During Consultations for Obstructive Sleep-Disordered Breathing in Children," was published online in JAMA Ontolaryngology.