Treatment recommendations to parents during pediatric tonsillectomy consultations: A mixed methods analysis of surgeon language

Objective: A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. We characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. Methods: We qualitatively analyzed surgeon recommendations from 55 encounters between otolaryngologists and parents of children evaluated for tonsillectomy, and classified recommendation types by phrasing. Multilevel logistic regression identified predictors of recommendation phrasing. Results: Clinicians provided 183 recommendations (mean/visit = 3.3). We identified four domains of recommendation-phrasing (direct, passive, acceptable, parent-oriented). Direct recommendations (n = 68, 37%) included presumptive statements phrasing intentions as inevitable. Passive recommendations (n = 65, 36%) included practice-based recommendations utilizing general statements. Acceptable recommendations (n = 29, 16%) included speaking positively about treatment options. Parent-oriented recommendations (n = 21, 11%) included parent choice statements. Clinicians more commonly made direct recommendations to parents who were racial minorities (OR = 2.7, p =.02, 95% CI [1.7, 5.9]) or had an annual income <$50,000 (OR = 2.2, p =.03, 95% CI [1.1, 4.4]). Conclusion: Clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions. Practice implications: Findings may be implemented into training which increases clinician awareness of dialogue use when recommending treatment alternatives to patients.