Patient-centered communication in pediatric emergency medicine: A foundational investigation of physician behaviors

PROJECT SUMMARY Patient-centered communication improves health outcomes, yet is under-utilized in the pediatric emergency department (PED). The PED is a high-stress environment in which physicians and families quickly establish rapport and exchange information in brief, fragmented interactions despite never having met previously, while PED physicians engage in complex decision making with high levels of uncertainty for multiple patients concurrently. This creates barriers to patient-centered communication, which may negatively impact the quality of care provided to acutely ill and injured children. Dr. Colleen Gutman is an Assistant Professor of Pediatric Emergency Medicine at the University of Florida. Her long-term goal is to become an independently funded physician-scientist with a focus on investigating and implementing strategies to promote patient-centered pediatric emergency care. Through the support of a KL2 award, Dr. Gutman gained introductory skills in multi-center research, qualitative analysis, and health communication science. To achieve a successful transition to research independence, Dr. Gutman and her multidisciplinary mentorship team devised a career development plan that builds from that foundation. With this K23 award, Dr. Gutman will develop advanced skills in 1) the conduct of parent-engaged research, 2) the science of patient-centered communication, 3) advanced mixed methods, 4) academic leadership, and 5) scientific writing. The career development plan will be complemented by mentored research experiences. Using the NIMHD Research Framework, the proposed research seeks to define elements of the physician-parent interaction that contribute to child health outcomes. The objective is to define factors that influence the use of patient-centered communication behaviors in the PED. This is a necessary first step that will inform targeted interventions aimed at improving the health of all acutely ill and injured children. In Aim 1, Dr. Gutman will use a parent-engaged modified Delphi approach to establish physician behaviors (e.g., assumptions about parent characteristics and access to resources; communication with parents) that are critical for patient-centered communication in PED care. In Aim 2, she will collect paired questionnaires from PED physicians and parents. She will analyze physician-parent response concordance on items evaluating parent characteristics and access to resources. Through this analysis, she will assess for clinical and patient-level factors that are associated with the accuracy of physician assumptions. In Aim 3, she will video-record PED encounters to analyze the relationship between clinical and patient-level factors and physician communication. The findings will inform a multicenter R01 proposal that is fully powered to conduct a mediation analysis assessing the relative importance of the defined factors and behaviors on patient-centered health outcomes. Long term, this research will inform targeted interventions to promote patient-centered communication and improve the health of acutely ill and injured children.