"Let Us Take Care of the Medicine": A Qualitative Analysis of Physician Communication When Caring for Febrile Infants

Overview

Journal Acad Pediatr

Publisher Elsevier

Date 2024 Mar 8

PMID 38458491

Authors

Colleen K Gutman

Rosemarie Fernandez

Antionette McFarlane

Joanna M T Krajewski

K Casey Lion

Paul L Aronson

Carma L Bylund

Sherita Holmes

Carla L Fisher

Affiliations

Soon will be listed here.

Abstract

Background: Guidelines for the management of febrile infants emphasize patient-centered communication. Although patient-centeredness is central to high-quality health care, biases may impact physicians' patient-centeredness. We aimed to 1) identify physicians' assumptions that inform their communication with parents of febrile infants and 2) examine physicians' perceptions of bias.

Methods: We recruited physicians from 3 academic pediatric emergency departments (EDs) for semistructured interviews. We applied a constant comparative method approach to conduct a thematic analysis of interview transcripts. Two coders followed several analytical steps: 1) discovery of concepts and code assignment, 2) identification of themes by grouping concepts, 3) axial coding to identify thematic properties, and 4) identifying exemplar excerpts for rich description. Thematic saturation was based on repetition, recurrence, and forcefulness.

Results: Fourteen physicians participated. Participants described making assumptions regarding 3 areas: 1) the parent's affect, 2) the parent's social capacity, and 3) the physician's own role in the parent-physician interaction. Thematic properties highlighted the importance of the physician's assumptions in guiding communication and decision-making. Participants acknowledged an awareness of bias and specifically noted that language bias influenced the assumptions that informed their communication.

Conclusions: ED physicians described subjective assumptions about parents that informed their approach to communication when caring for febrile infants. Given the emphasis on patient-centered communication in febrile infant guidelines, future efforts are necessary to understand how assumptions are influenced by biases, the effect of such behaviors on health inequities, and how to combat this.

References

Keenan H, Campbell K, Page K, Cook L, Bardsley T, Olson L . Perceived social risk in medical decision-making for physical child abuse: a mixed-methods study. BMC Pediatr. 2017; 17(1):214. PMC: 5741958. DOI: 10.1186/s12887-017-0969-7. View

Zestcott C, Blair I, Stone J . Examining the Presence, Consequences, and Reduction of Implicit Bias in Health Care: A Narrative Review. Group Process Intergroup Relat. 2016; 19(4):528-542. PMC: 4990077. DOI: 10.1177/1368430216642029. View

Janke A, Mangus C, Fung C, Kamdar N, Macy M, Nypaver M . Emergency Department Care for Children During the 2022 Viral Respiratory Illness Surge. JAMA Netw Open. 2023; 6(12):e2346769. PMC: 10704279. DOI: 10.1001/jamanetworkopen.2023.46769. View

Gutman C, Aronson P, Singh N, Pickett M, Bouvay K, Green R . Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants. JAMA Pediatr. 2023; 178(1):55-64. PMC: 10644247. DOI: 10.1001/jamapediatrics.2023.4890. View

Paxton R, Byington C . An examination of the unintended consequences of the rule-out sepsis evaluation: a parental perspective. Clin Pediatr (Phila). 2001; 40(2):71-7. DOI: 10.1177/000992280104000202. View

Park J, Saha S, Chee B, Taylor J, Beach M . Physician Use of Stigmatizing Language in Patient Medical Records. JAMA Netw Open. 2021; 4(7):e2117052. PMC: 8281008. DOI: 10.1001/jamanetworkopen.2021.17052. View

Woll C, Neuman M, Pruitt C, Wang M, Shapiro E, Shah S . Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments. J Pediatr. 2018; 200:210-217.e1. PMC: 6109608. DOI: 10.1016/j.jpeds.2018.04.033. View

Maina I, Belton T, Ginzberg S, Singh A, Johnson T . A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Soc Sci Med. 2017; 199:219-229. DOI: 10.1016/j.socscimed.2017.05.009. View

Byington C, Reynolds C, Korgenski K, Sheng X, Valentine K, Nelson R . Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics. 2012; 130(1):e16-24. PMC: 4074609. DOI: 10.1542/peds.2012-0127. View

10.

Aronson P, Schaeffer P, Niccolai L, Shapiro E, Fraenkel L . Parents' Perspectives on Communication and Shared Decision Making for Febrile Infants ≤60 Days Old. Pediatr Emerg Care. 2020; 37(12):e1213-e1219. PMC: 7371504. DOI: 10.1097/PEC.0000000000001977. View

11.

Carpenter J, Catalanotti J, Notis M, Brokus C, Moran T, Akselrod H . Use of nonstigmatizing language is associated with improved outcomes in hospitalized people who inject drugs. J Hosp Med. 2023; 18(8):670-676. PMC: 10524912. DOI: 10.1002/jhm.13146. View

12.

Johnson T, Hickey R, Switzer G, Miller E, Winger D, Nguyen M . The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias. Acad Emerg Med. 2016; 23(3):297-305. PMC: 5020698. DOI: 10.1111/acem.12901. View

13.

FitzGerald C, Hurst S . Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017; 18(1):19. PMC: 5333436. DOI: 10.1186/s12910-017-0179-8. View

14.

Street Jr R, Makoul G, Arora N, Epstein R . How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009; 74(3):295-301. DOI: 10.1016/j.pec.2008.11.015. View

15.

Goddu A, OConor K, Lanzkron S, Saheed M, Saha S, Peek M . Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J Gen Intern Med. 2018; 33(5):685-691. PMC: 5910343. DOI: 10.1007/s11606-017-4289-2. View

16.

Kelley J, Kraft-Todd G, Schapira L, Kossowsky J, Riess H . The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014; 9(4):e94207. PMC: 3981763. DOI: 10.1371/journal.pone.0094207. View

17.

Rao J, Anderson L, Inui T, Frankel R . Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care. 2007; 45(4):340-9. DOI: 10.1097/01.mlr.0000254516.04961.d5. View

18.

Knopp R, Rosenzweig S, Bernstein E, Totten V . Physician-patient communication in the emergency department, part 1. Acad Emerg Med. 1996; 3(11):1065-9. DOI: 10.1111/j.1553-2712.1996.tb03357.x. View

19.

Bylund C, Peterson E, Cameron K . A practitioner's guide to interpersonal communication theory: an overview and exploration of selected theories. Patient Educ Couns. 2011; 87(3):261-7. PMC: 3297682. DOI: 10.1016/j.pec.2011.10.006. View

20.

Lee T, Aronson P . To Spinal Tap or Not To Spinal Tap, That Is the Question. Hosp Pediatr. 2018; 8(4):236-238. PMC: 5869341. DOI: 10.1542/hpeds.2017-0207. View