在扁桃体切除术会诊期间与超重或肥胖儿童家庭的沟通。

IF 5.6 1区 医学 Q1 OTORHINOLARYNGOLOGY
Ashwin Ram Reddy, Serin Baek, Anne R Links, Liliana Rodriguez, Mary Catherine Beach, Emily F Boss, Chenery Lowe
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引用次数: 0

摘要

重要性:超重或肥胖儿童在扁桃体切除术后出现阻塞性睡眠呼吸障碍和持续性睡眠呼吸暂停的患病率、严重程度和围手术期风险更高。然而,关于体重状况如何影响外科医生和家庭在术前会诊中的沟通,我们知之甚少。目的:评估患者体重状况与(1)医生与家长沟通和(2)家长在扁桃体切除术咨询期间护理经验评分之间的关系。设计、环境和参与者:本横断面研究调查了2016年4月至2023年9月期间在耳鼻喉科门诊就诊的2至17岁儿童的英语家长接受扁桃体切除术初步评估和临床医生(外科医生和高级实践医疗专业人员)评估扁桃体切除术患者的遭遇。数据分析时间为2023年9月至2024年5月。主要结果和措施:使用Roter互动分析系统对咨询进行录音和编码,以识别语言和非语言沟通行为。咨询后,临床医生对儿童体重状况进行评分,家长对护理经历进行评分,使用的项目修改自《医疗保健提供者和系统消费者评估》。结果:在本研究的231例就诊中,50例(22%)为超重儿童。大多数儿童为男性(n = 130[57%])。2至17岁的儿童和青少年(以下简称儿童);平均[SD]年龄:无超重,5.0[2.6]岁;超重或肥胖,8.1[3.3]岁)。在言语支配、以病人为中心、临床医生促进或激活陈述、临床医生闲聊陈述或临床医生情绪陈述方面,超重组和非超重组之间没有差异。在对儿童种族、父母教育水平和家庭年收入进行调整后,通过标准化β = -0.18 SDs (95% CI, -0.65至0.00 SDs),儿童超重状况与累积临床医生积极整体影响水平的降低相关。观察到的小效应可能限制了这种关联的强度。此外,超重儿童的父母不太可能报告他们的临床医生明确表示尊重相对于没有超重儿童的父母(优势比,4.56 [95% CI, 1.06-19.99])。结论和相关性:这些研究结果表明,儿童体重状况与测量的语言交流行为无关,但与较低的父母评分和临床医生尊重的观察者评分有关。较小的效应量和来自临床医生种族、民族和性别的潜在偏见可能限制了这种关联。这些结果表明,有必要阐明和减轻对超重儿童的护理和沟通质量产生负面影响的多层次决定因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Communication With Families of Children With Overweight Status or Obesity During Consultation for Tonsillectomy.

Importance: Children with overweight or obesity experience greater prevalence, severity, and perioperative risk of obstructive sleep-disordered breathing and persistent sleep apnea after tonsillectomy. Yet, little is known about how weight status influences communication between surgeons and families in presurgical consultations.

Objectives: To evaluate the association between patient weight status with (1) clinician-parent communication and (2) parent ratings of care experience during tonsillectomy consultations.

Design, setting, and participants: This cross-sectional study examined encounters occurring between April 2016 and September 2023 at outpatient otolaryngology clinics among English-speaking parents of children aged 2 to 17 years undergoing initial evaluation for tonsillectomy and clinicians (surgeons and advanced practice medical professionals) evaluating patients for tonsillectomy. Data were analyzed from September 2023 to May 2024.

Main outcomes and measures: Consultations were audio recorded and coded using the Roter Interaction Analysis System to identify verbal and nonverbal communication behaviors. After consultations, clinicians rated child weight status and parents rated care experiences using items modified from the Consumer Assessment of Healthcare Providers & Systems.

Results: Of 231 encounters in this study, 50 (22%) were with children with overweight. Most children were male (n = 130 [57%]). Children and adolescents were aged 2 to 17 years (hereafter referred to as children; mean [SD] age: no overweight, 5.0 [2.6] years; overweight or obesity, 8.1 [3.3] years). There were no differences between the groups with and without overweight in verbal dominance, patient centeredness, clinician facilitation or activation statements, clinician chit-chat statements, or clinician emotional statements. After adjusting for child's race, parents' education level, and annual household income, the child overweight status was associated with a decrease in cumulative clinician positive global affect levels by standardized β = -0.18 SDs (95% CI, -0.65 to 0.00 SDs). The small effect size observed may have limited the strength of this association. Furthermore, parents of children with overweight were less likely to report that their clinician definitively demonstrated respect relative to parents of children without overweight (odds ratio, 4.56 [95% CI, 1.06-19.99]).

Conclusion and relevance: These findings suggest that child weight status was not associated with measured verbal communication behaviors but was associated with lower parent ratings and observer ratings of clinician respectfulness. The small effect size and potential bias from clinician race and ethnicity and sex may have limited this association. These results indicate the need to elucidate and mitigate multilevel determinants that negatively affect quality of care and communication for children with overweight.

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来源期刊
CiteScore
9.10
自引率
5.10%
发文量
230
期刊介绍: JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.
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