O3274: Are You Listening? The Experience of Black Parents and Caregivers in Accessing Pediatric Orthopaedic Care

Background: Multiple studies have demonstrated that healthcare disparities exist between Black and white patients in the United States, largely attributable to systemic historical inequities that remain pervasive. The effect of race on physician-patient communication in clinical interactions has been less well studied, although it is conceivable that this relationship is affected by underlying implicit biases and differences in cultural awareness. In this context, we aimed to evaluate if parent or caregiver perception of physician-patient communication varies by race, and if racial concordance between the parent/caregiver, patient, and physician affects this perception.

Methods: Custom surveys assessing physician-caregiver communication were given to patients’ parents/caregivers following visits with 9 fellowship-trained pediatric orthopaedic surgeons (3 Black physicians, 6 white physicians) at two tertiary-care institutions between 2022-2024. Surveys included 16 questions grouped into subdomains including “communication” and “shared decision-making”, both validated measures drawn from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Caregivers were then asked to assign an overall rating of their physician on a 0-10 numerical scale. Household socioeconomic and demographic data were also collected.
Based on self-identified race, visits were designated as concordant (same caregiver-patient-physician race) or discordant (different caregiver or patient from physician race). By a priori power analysis, 158 surveys with an equal number of concordant and discordant surveys per physician were required. We compared survey responses between all Black and white caregivers and also between matched concordant-discordant visits. Validated measures and numerical scores were compared using Mann-Whitney U tests. Non-validated questions were compared using Fisher’s tests.

Results: A total of 432 surveys with a mean of 48.0 ± 40.9 surveys per physician were collected, including 254 matched concordant-discordant surveys. There were significant demographic differences between Black and white caregivers including gender and relationship of caregiver present (p=0.002, Table 1), household income, and highest level of education (p < 0.01, Table 1). Black parents/caregivers gave significantly lower ratings on the overall CAHPS communication domain ( < 0.01) and on individual questions regarding the physician offering easy-to-understand explanations, listening carefully, showing respect, and spending enough time with the patient (p < 0.05, Table 1). Black caregivers also indicated they felt comfortable asking questions to their provider less often than their white counterparts (p=0.04, Table 1). This discrepancy persisted despite caregiver-physician race concordance.

Conclusion: Black parents and caregivers report inferior perceptions of communication with pediatric orthopaedic surgeons compared to white counterparts. This discrepancy did not change based on racial concordance. Larger samples from multiple geographic regions are necessary before determining the generalizability and implications of these findings. Further qualitative research is required to identify potential strategies for improved communication with Black caregivers and patients.