"Safer than driving": Risk communication about surgery with racially diverse families in pediatric urology visits.

Abstract

To examine how pediatric urologists and families invoke and manage surgery-related risk discussions during face-to-face visits. We used Reflective Interventionist Conversation Analysis to examine a dataset of 19 risk discussion sequences across 11 video-recorded visits with a racially and ethnically diverse sample of pediatric urology patients and families. All data are United States English. Our analysis identified three patterns. Risk discussions 1) usually took place late within the general structure of visits, 2) most often occurred during or after gathering and discussing diagnostic evidence and treatment options, and 3) sometimes occurred in response to interactional difficulties (e.g., disagreement with treatment recommendations). Urologist-initiated risk discussions were formulated as information or as resources to respond to interactional problems. Notably, caregivers rarely initiated conversations about risks, but they often disclosed concerns after urologists implied or introduced notions of risk. The practices urologists used reveal how urologists and families negotiated and treated risks as sensitive yet salient matters in real-time encounters. More research on risk communication in pediatric surgical specialties with racially diverse populations is needed to bridge knowledge and health equity gaps. This study's findings have implications for creating pediatric risk communication training informed by evidence from real-time encounters, developing strategies for involving children in surgery-related risk discussions, and enhancing surgery-related risk communication with structural competency training.