Qualitative study of Black and Latino (a/e) caregiver participation on family-centered rounds.

Abstract

Family-centered rounds (FCR), multi-disciplinary rounds at bedside that involve the patient and family, has become the standard of care in pediatric hospitalizations. Caregiver participation on FCR improves shared-decision making and communication among providers, patients, and families. Evidence suggests Black and Latino (a/e) caregivers participate less during FCR than White caregivers, likely due to interpersonal and structural inequities, however contributing factors have not been adequately explored. To better understand factors positively and negatively influencing Black and Latino (a/e) participation during FCR. We conducted a qualitative study of Black and Latino(a/e) caregivers and attending clinicians of hospitalized children admitted to a general pediatrics team at a tertiary care children's hospital. We conducted virtual semi-structured interviews to assess factors that promoted and hindered caregiver participation on FCR. Clinician interviews addressed experiences encouraging caregiver participation on FCR with a focus on Black and Latino(a/e) caregivers. Investigators worked together to organize codes into common themes, select representative quotes, and create a conceptual framework. We conducted 21 interviews (14 caregivers, 7 clinicians) at an academic medical center. From our interviews, caregivers and their clinicians identified four major themes that influenced caregiver participation during rounds: 1) verbal and nonverbal interpersonal communication, 2) shared understanding and language, 3) structural factors (team size and time pressures), and 4) race, racism, and previous healthcare experiences. Caregivers and their clinicians identified structural and modifiable clinician and health system factors that can promote Black and Latino (a/e) participation on FCR. Future research and interventions focused on these factors may improve not only racial inequities in clinician-caregiver communication, but also pediatric health outcomes.