Pilot Testing of an Equity Focused and Trauma-informed Communication Intervention During Family-centered Rounds
- Conditions
- Hospitalism in ChildrenPost Traumatic Stress Disorder
- Registration Number
- NCT05618652
- Lead Sponsor
- Duke University
- Brief Summary
Development and pilot testing of a clinician coaching communication intervention to improve communication between medical teams and caregivers (parents, family members) of children in the hospital. Our team is specifically focused on improving partnership, respect, and collaboration with Black and Latinx caregivers of children in the hospital by incorporating elements from trauma-informed care and racial equity into a communication intervention. The investigators will explore the impact of this intervention on communication quality, caregiver trust, caregiver satisfaction, and hospital readmissions.
- Detailed Description
When admitted to the hospital, Black and Latino(a/x) children are at greater risk of medical errors, surgical complications, longer, more-costly hospital stays, and mortality compared to White children. Although many factors play a role, poor clinician communication likely contributes to these disparities in health outcomes. Across settings, including our preliminary work in the inpatient pediatric environment, Black and Latino(a/x) patients have been shown to experience worse communication quality as evidenced by less patient and family-centered, empathic, and respectful communication as compared to White patients. Poor communication can make the hospital stay more stressful for caregivers, with implications for caregiver and child health and recovery from illness. While prior experiences of discrimination and trauma can negatively affect clinician-caregiver communication, current best practices in clinician communication fail to incorporate equity and trauma-informed principles. In this study the investigators will test the feasibility, acceptability, and preliminary efficacy of a pilot randomized waitlist control trial of an equity focused and trauma-informed clinician coaching communication intervention that aims to teach clinicians skills to improve communication in areas where inequities are known to exist (i.e. respect, partnership) and incorporate principles of equity (i.e affirmation) and trauma-informed care. To do this, first the investigators will co-develop and refine a clinician coaching communication intervention with iterative feedback from Black and Latino(a/x) caregivers as well as clinicians of children in the hospital. Second, the investigators will examine the feasibility, acceptability and preliminary efficacy of the intervention. The investigators will randomize 10 clinicians to an intervention or waitlist group; clinicians in the intervention group will receive the intervention immediately, while clinicians in the waitlist group will initially serve as the control arm then receive the intervention to provide feasibility and acceptability data. The investigators will assess the feasibility of recruiting and collecting data as well as acceptability of the intervention by clinicians. The investigators will explore preliminary efficacy for the effect of the intervention on communication, caregiver satisfaction, caregiver trust, and hospital readmissions.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 90
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Primary Outcome Measures
Name Time Method Feasibility measured by enrollment rate of clinicians and caregivers combined Up to 12 months Feasibility measured by the rate of complete data collection by caregivers Up to 12 months Fidelity measured by the rate of intervention elements completed per encounter by clinicians Up to 12 months Acceptability of the intervention as measured by the Acceptability of Intervention Measure (AIM) Up to 12 months The AIM has 4 items. Each with response of 5 point likert scale (completely disagree to completely agree). The Investigator will assign a score of 1 to completely disagree and a 5 to completely agree for each item. To calculate the AIM the Investigator average together the responses to the 4 items.
Appropriateness measured by the Intervention Appropriateness Measure (IAM) Up to 12 months The IAM has 4 items. Each with response of 5 point likert scale (completely disagree to completely agree). The Investigator will assign a score of 1 to completely disagree and a 5 to completely agree for each item. To calculate the AIM the Investigator average together the responses to the 4 items.
Feasibility measured by the Feasibility of Intervention Measure (FIM) Up to 12 months The FIM has 4 items. Each with response of 5 point likert scale (completely disagree to completely agree). The Investigator will assign a score of 1 to completely disagree and a 5 to completely agree for each item. To calculate the AIM the Investigator average together the responses to the 4 items.
Number of Clinician rapport-building statements Up to 12 months Clinician communication behaviors measured via audio-recorded hospital encounters.
Number of Clinician partnership-building statements Up to 12 months Clinician communication behaviors measured via audio-recorded hospital encounters.
Number of Clinician interruptions Up to 12 months Clinician communication behaviors measured via audio-recorded hospital encounters.
Number of Clinician praise statements Up to 12 months Clinician communication behaviors measured via audio-recorded hospital encounters.
Number of Clinician permission asking Up to 12 months Clinician communication behaviors measured via audio-recorded hospital encounters.
Caregiver Satisfaction measured by survey Up to 12 months 1 item question on the post-rounds caregiver survey. Response choices will include: not at all satisfied, a little satisfied, satisfied, and extremely satisfied.
Caregiver Trust in their Childs Doctors measured by the Wake Forest Physician Trust Scale Up to 12 months The Wake Forest Physician Trust Scale is a validated 5 item instrument on the post-rounds caregiver survey. Responses to the 5 items are summed together and can vary from a score of 5-25. A higher score indicates a more positive outcome.
Caregiver Reported Communication Quality measured by the Interpersonal Processes of Care Short Form Up to 12 months The interpersonal processes of care measure has 18 items on the short form, each with response of Never (score=1), Rarely (Score=2), Sometimes (Score=3), Usually (Score=4), Always(Score=5). The Investigator will average together responses from the 18 items to give a value from 1-5 for each domain.
Caregiver Stress Timeframe up to 12 months Measured by salivary cortisol levels
- Secondary Outcome Measures
Name Time Method Number of Caregiver Participatory Behaviors Up to 12 months The investigators will measure caregiver participation during clinical encounters by counting the number of times caregivers (1) ask a question, (2) state a preference and (3) express an emotion per clinician encounter. These three behaviors will be summed together and analyzed in aggregate as a count of caregiver participatory behaviors.
Number of participants with Hospital Readmission at 30 days 30 days after discharge Child unplanned hospital readmission
Number of participants with Hospital Readmission at 90 days 90 days after discharge Child unplanned hospital readmission
Caregiver ability to correctly identify child's diagnosis Up to 12 months Using validated approach described by Lion et al. the caregiver description of "the main condition child was admitted for" will be compared to the diagnoses listed by the child's doctors in the electronic health record.
Change in caregiver Salivary Cortisol 30-60 minutes before and 20-30 minutes after FCR The investigators will assess for reductions in caregiver salivary cortisol following interactions with clinical teams. The investigators will collect saliva samples from caregivers at two time points: 30-60 minutes before and 20-30 minutes after family-centered rounds (FCR). The investigators anticipate lower salivary cortisol levels in the intervention compared to control arm at 20-30 minutes following FCR. The investigators will also compare differences in the change in cortisol from before and after FCR for each caregiver; the investigators hypothesize caregivers in the intervention arm will have a smaller change from baseline following FCR.
Trial Locations
- Locations (1)
Duke University Health Sustem
🇺🇸Durham, North Carolina, United States
Duke University Health Sustem🇺🇸Durham, North Carolina, United States