Treatment recommendations to parents during pediatric tonsillectomy consultations: A mixed methods analysis of surgeon language

•Treatment recommendation phrasing varies, utilizing strong and passive language.•Clinicians provide more direct recommendations to racial/ethnic minority parents.•Clinicians provide more direct recommendations to low socioeconomic status parents.•Clinicians use more passive language when recommendi...

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Published in:Patient education and counseling 2021-06, Vol.104 (6), p.1371-1379
Main Authors: Links, Anne R., Callon, Wynne, Wasserman, Carly, Beach, Mary Catherine, Ryan, Marisa A., Leu, Grace R., Tunkel, David, Boss, Emily F.
Format: Article
Language:English
Subjects:
Communication
Nursing
Patient-centered
Pediatrics
Shared decision-making
Tonsillectomy
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cited_by cdi_FETCH-LOGICAL-c353t-fb3c44edc00e19cdf0bbddecb7ed10868501300c11eaee98f51a10a5895571a03
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container_title Patient education and counseling
container_volume 104
creator Links, Anne R.
Callon, Wynne
Wasserman, Carly
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description •Treatment recommendation phrasing varies, utilizing strong and passive language.•Clinicians provide more direct recommendations to racial/ethnic minority parents.•Clinicians provide more direct recommendations to low socioeconomic status parents.•Clinicians use more passive language when recommending surgery. A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. We characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. We qualitatively analyzed surgeon recommendations from 55 encounters between otolaryngologists and parents of children evaluated for tonsillectomy, and classified recommendation types by phrasing. Multilevel logistic regression identified predictors of recommendation phrasing. Clinicians provided 183 recommendations (mean/visit = 3.3). We identified four domains of recommendation-phrasing (direct, passive, acceptable, parent-oriented). Direct recommendations (n = 68, 37%) included presumptive statements phrasing intentions as inevitable. Passive recommendations (n = 65, 36%) included practice-based recommendations utilizing general statements. Acceptable recommendations (n = 29, 16%) included speaking positively about treatment options. Parent-oriented recommendations (n = 21, 11%) included parent choice statements. Clinicians more commonly made direct recommendations to parents who were racial minorities (OR = 2.7, p = .02, 95% CI [1.7, 5.9]) or had an annual income
doi_str_mv 10.1016/j.pec.2020.11.015
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A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. We characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. We qualitatively analyzed surgeon recommendations from 55 encounters between otolaryngologists and parents of children evaluated for tonsillectomy, and classified recommendation types by phrasing. Multilevel logistic regression identified predictors of recommendation phrasing. Clinicians provided 183 recommendations (mean/visit = 3.3). We identified four domains of recommendation-phrasing (direct, passive, acceptable, parent-oriented). Direct recommendations (n = 68, 37%) included presumptive statements phrasing intentions as inevitable. Passive recommendations (n = 65, 36%) included practice-based recommendations utilizing general statements. Acceptable recommendations (n = 29, 16%) included speaking positively about treatment options. Parent-oriented recommendations (n = 21, 11%) included parent choice statements. Clinicians more commonly made direct recommendations to parents who were racial minorities (OR = 2.7, p = .02, 95% CI [1.7, 5.9]) or had an annual income &lt;$50,000 (OR = 2.2, p = .03, 95% CI [1.1, 4.4]). Clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions. 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Acceptable recommendations (n = 29, 16%) included speaking positively about treatment options. Parent-oriented recommendations (n = 21, 11%) included parent choice statements. Clinicians more commonly made direct recommendations to parents who were racial minorities (OR = 2.7, p = .02, 95% CI [1.7, 5.9]) or had an annual income &lt;$50,000 (OR = 2.2, p = .03, 95% CI [1.1, 4.4]). Clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions. 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subjects Communication
Nursing
Patient-centered
Pediatrics
Shared decision-making
Tonsillectomy
title Treatment recommendations to parents during pediatric tonsillectomy consultations: A mixed methods analysis of surgeon language
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