Oral literacy in pediatric otolaryngology surgical consultations amongst parents with high levels of decisional conflict

Objectives: Oral literacy is an important aspect of physician and patient/family communication. Adequate communication is essential in the shared decision-making process and is inherently important in pediatric surgical consultations where parents must make decisions for their children. The aim of this study was to describe oral literacy in pediatric otolaryngology consultations and how it may relate to shared decision-making in a cohort of parents experiencing significant decisional conflict. Methods: Thirty-six parent/patient-physician interactions from two pediatric otolaryngology clinics were recorded. Parents completed the Decision Conflict Scale (DCS), and both parents and physicians completed the Shared Decision-making (SDM-Q-9/SDM-Q-Doc) questionnaires. Language complexity was assessed by the Flesch Reading Ease Scale (FRES), the Simple Measure of Gobbledygook (SMOG) Readability Formula, and a series of grammar statistics. The Pearson product-moment was used to examine the correlation between measures. Results: The mean age of parents was 32.3 (mother) and 34.8 (father) years, with the majority having a college education or greater (77.8%). The mean DCS score was 85.8 (range 56–100), and all parents reported clinically significant conflict scores (DCS score > 25). Physicians spoke at a higher-grade level (mean difference SMOG 1.2 (95% CI: 0.8–1.6)), with more words per sentence (mean difference 3.7 (95% CI: 2.4–4.9)), and longer words (mean difference 0.1 (95% CI: 0.03–0.16)). Parents who had higher language complexity experienced less decisional conflict (SMOG vs DCS, r = −0.471, p = 0.004; words per sentence, r = −0.414, p = 0.012; word length, r = −0.419, p = 0.011), but there was no correlation between physician language complexity and DCS or SDM-Q-9 scores. Conclusion: Physicians demonstrated higher language complexity than that of parents in this study. Differences in language complexity between physicians and parents do not appear to play a substantial role in decisional conflict or the perception of shared decision-making in general. However, parents who use a more complex vocabulary may experience less conflict.