Doctor-child communication and caregivers' willingness to recommend hospital: a secondary analysis using pediatric patient experience data.

Background: Doctor-child communication is central to pediatric care, yet current research often marginalizes child-centered interactions and fails to isolate which specific behaviors drive systemic hospital metrics. This study addresses these gaps by using The Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) framework to deconstruct communication into three discrete behaviors. We aimed to assess their distinct effects on caregivers' overall hospital rating and willingness to recommend, thereby clarifying the link between triadic clinical interactions and institutional loyalty. Methods: A retrospective multicenter analysis was conducted using cross-sectional survey data from the validated Chinese version of the Child HCAHPS. The sample included caregivers of pediatric inpatients discharged from six top-tier National Regional Centers for Pediatrics (NRCP) in China, ensuring geographic and institutional diversity. Data on caregiver perceptions of the three doctor-child communication behaviors, overall hospital rating, and willingness to recommend were collected upon discharge. Ordinal logistic regression models were employed to examine associations, adjusting for key covariates including child's global health status and caregiver demographics. A path analysis was then conducted to quantify the indirect association of the overall hospital rating. Results: Among 1,010 triadic participants, 59.2% of children were male, 85.0% were under 12 years of age, 68.5% of respondents were mothers, and the overall Top-Box rate was 88.4% for hospital rating and 90.4% for recommendation willingness. Encouraging the child to ask questions was significantly associated with overall hospital ratings [β=1.075, 95% confidence interval (CI): 0.141-2.009] and willingness to recommend the hospital (β=1.382, 95% CI: 0.425-2.339). The child's perceived health status was a significant covariate for overall hospital ratings. Path analysis revealed that the overall hospital rating partially mediated the relationship between encouraging questions and recommendation willingness (indirect association β=0.338, 95% CI: 0.206-0.471), accounting for 57.81% of the total association. Conclusions: Encouraging children to ask questions emerges as a pivotal, distinct communication practice that directly enhances caregiver loyalty and indirectly strengthens it through an improved overall perception of the hospital. This finding underscores that empowering child participation transcends simple information exchange, representing a core component of patient-centered care in triadic clinical encounters. Strengthening this and other child-centered communication behaviors through targeted clinician training and supportive healthcare system design should be a priority for improving perceived pediatric care quality and fostering family trust and advocacy.