Patient-Clinician Communication About Traumatic Experiences: A Qualitative Dyadic Framework Analysis

Abstract

Background: Over 70% of adults have lived through a traumatic event, which can have long-term physical and mental health repercussions. However, there is limited understanding of how to effectively communicate with patients about trauma or how trauma-related communication impacts patient outcomes. Objective: Evaluate patient and clinician perspectives on communicating about traumatic experiences and the impact on health. Design: Semi-structured qualitative interviews completed from April 2023 to 2024 at two primary care safety-net clinics in Northern California. Participants: Forty-eight participants (patients [n = 24] who had experienced trauma and their primary care clinicians [n = 24; 20 physicians, 4 nurse practitioners]). Approach: Seven multidisciplinary researchers with clinical and qualitative expertise completed a two-phase (intra- and inter-) dyadic analysis using the framework method to analyze incongruencies and similarities within and between patient-clinician dyads. Patients and clinicians within dyads were interviewed separately, by the same interviewer. A hybrid of inductive and deductive reasoning was used to create and apply a codebook. All interviews were double-coded. Results: The analysis identified five themes related to (1) communication about trauma positively affecting treatments, health outcomes, and social needs; (2) the importance of patient-clinician relationships and continuity; (3) best practices for supportive trauma inquiry and response; (4) differences between patients and clinicians regarding the perceived risks of trauma-related communication; and (5) the need to address environmental and structural barriers to trauma recovery. Conclusions: Supportive communication about trauma has the potential to be independently therapeutic on its own, underscoring its importance in clinical care and training. Participants reported that discussing trauma that occurred as an adult or as a child could have significant health benefits with minimal harm to patients. Results identify strategies to optimize communication that can inform clinician trainings on trauma-related communication, clinical policies regarding continuity of care and operationalizing trauma-care pathways, and allocation of resources to address external factors impeding trauma recovery.