Experiences of Past Discrimination and Caregiver Communication During Family-Centered Rounds.

OBJECTIVES: The objective of this study was to assess the relationship between experiences of past discrimination (ie, discrimination) and caregiver participatory behaviors during family-centered rounds (FCR). METHODS: We conducted a mixed-methods cross-sectional study investigating the association between discrimination among Black and Latino(a/e) caregivers and communication on FCR from February 2024 to April 2025. FCR were audio-recorded, and caregivers completed surveys that collected demographics, ratings of interpersonal processes of care (IPC), and discrimination. Discrimination was measured using an abbreviated validated Experiences of Discrimination instrument. We stratified caregivers into 3 groups: no discrimination, discrimination in health care, and discrimination outside of health care. Staff coded the type and content of caregiver participatory behaviors. Kruskal-Wallis testing compared survey and coded measures among the 3 groups. RESULTS: We recorded, transcribed, and coded FCR with 56 Black and Latino(a/e) caregivers; 30 (54%) reported no discrimination, 18 (32%) reported discrimination outside of health care, and 8 (14%) reported discrimination in health care. Caregivers with discrimination in health care asked a higher median (IQR) number of questions per interaction (5 [2, 8]) compared with those with no discrimination (1 [0, 3]) and discrimination outside of health care (1.5 [1, 4]; P = .03). They made more assertive statements (4.5 [3.5, 5.5]) compared with those with no discrimination (2 [0, 2]) and discrimination outside of health care (0.5 [0-2]; P < .001). Other significant associations included increased behaviors categorized as advocacy and seeking medical understanding. IPC ratings were significantly lower in the interpersonal style domain for these caregivers. CONCLUSIONS: Discrimination in health care is associated with increased caregiver participatory behaviors on FCR. These behaviors, which may represent increased caregiver vigilance, support clinician use of trauma-informed communication.

Duke Scholars

Author Victoria Marie Parente Pediatrics, Hospital Medicine