# Project ReDIreCTS: Reducing Disparities through Improved Communication in Tonsillectomy and Sleep

> **NIH NIH R56** · JOHNS HOPKINS UNIVERSITY · 2021 · $629,505

## Abstract

PROJECT SUMMARY/ABSTRACT
Obstructive sleep-disordered breathing (OSDB) occurs in up to 20% of children and impacts physical,
behavioral, and neurocognitive health. The primary treatment for OSDB in children is tonsillectomy, with or
without adenoidectomy, which is the most common major surgical procedure performed in U.S. children.
Tonsillectomy is a `preference-sensitive' procedure, as some children experience resolution of symptoms
without treatment. As such, clinicians are encouraged to use shared decision-making to ensure parents make
the right treatment choice for their child. Effective communication is paramount to incorporate family values
into decisions about surgery. Children who are black, Hispanic, or low-income have increased prevalence of
OSDB, worse sleep outcomes, and more complications of surgery. Although clinical and environmental
determinants contribute to these disparities, negative attitudes of clinicians also contribute to poor care
delivery and outcomes, particularly for vulnerable populations. We have previously shown that surgeons
rarely elicit family preferences when speaking to parents, and that they more commonly make directive
recommendations to minority families. These findings suggest that surgeons may harbor biases that influence
treatment decisions and potentially lead to disparities in outcomes. Our long-term goal is to improve equity,
healthcare quality, and outcomes for children with OSDB. The overall objective of this application is to develop
a comprehensive profile of the complex interpersonal dynamics, including potential surgeon bias, parent trust,
and surgeon-parent communication that may affect treatment decisions and cause disparate patient
outcomes for minority children. To accomplish this objective, we will establish a repository of audio-recorded
visits between surgeons and parents of children undergoing surgical consult for OSDB and embed these
recordings within a longitudinal cohort. We will first evaluate how surgeon-parent communication impacts
patient and family outcomes. We will code communication from audio-recorded patient visits and evaluate
communication quality as defined by patient-centeredness, emotional responsiveness, language complexity,
and shared decision-making. We will then evaluate the association of communication with clinical and parent-
reported outcomes including postoperative revisits, knowledge, trust, and decision regret. Next, we will learn
what parents perceive as `good' communication through stimulated recall interviews where parents hear their
recently recorded consultations as stimulus to evaluate preferences for dialogue and impact on treatment
decisions. Finally, we will assess the influence of parent race/ethnicity and implicit surgeon bias on outcomes,
and learn whether `good' communication mediates any observed disparities. Findings from this research will
inform development of interventions that elucidate surgeon bias and promote culturally competent
communicati...

## Key facts

- **NIH application ID:** 10098888
- **Project number:** 1R56HL155580-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Emily Frances Boss
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $629,505
- **Award type:** 1
- **Project period:** 2021-09-20 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10098888

## Citation

> US National Institutes of Health, RePORTER application 10098888, Project ReDIreCTS: Reducing Disparities through Improved Communication in Tonsillectomy and Sleep (1R56HL155580-01). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10098888. Licensed CC0.

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