Are We Like Our Patients: How Surgeon-Perceived Cultural Similarity to Parents Influences Interpersonal Communication

Introduction: Surgeons may communicate differently with patients based on implicit attitudes or likeness. We explored differences in surgeon-parent communication based on surgeon perceived cultural similarity to parents.

Methods: Audio-recordings of initial elective pediatric surgical consultations were coded using the Roter Interaction Analysis System, a quantitative communication coding system developed for medical interactions. Surgeons rated their post-encounter perception of similarity to parents on a 6-point Likert scale (Perceived Cultural Similarity Measure, Street et al.); scores were dichotomized as less or more similar based on the mean. Two-sample t-tests assessed the association between perceived cultural similarity and surgeon communication behaviors (verbal dominance, patient-centeredness, emotional statements, and facilitation/activation statements i.e., statements asking for parents' opinions and understanding).

Results: 130 consultations among 16 surgeons were analyzed. Mean perceived similarity score was 17.5 for surgeons (range, 5-24). In consultations where surgeons perceived more similarity to the parent, surgeons were less verbally dominant (more vs less similar, mean [SD]= 1.41 [.47] vs 1.59 [.52]; p=0.016), used less facilitation/activation statements (more vs less similar, mean [SD] 25.78 [1.62] vs. 31.22 [2.27]; p=0.023), and had visits with higher patient-centeredness scores (more vs less similar, mean [SD] 0.38 [0.01] vs. 0.35 [0.02]; p=0.048). No differences between the groups were found with emotional statements.

Conclusions: More surgeon perceived similarity with parents was associated with more patient-centeredness and less verbal dominance during encounters. During visits with less perceived similarity, surgeons used more facilitation/activation statements, which may represent efforts to understand the parents’ perspectives. These findings can inform future strategies to improve patient-centered communication and mitigate effects of implicit bias on communication and decision-making in surgery.