A QUALITATIVE STUDY OF COMMUNICATION CRISES IN THE PEDIATRIC IN-PATIENT SETTING: A 360O PERSPECTIVE

Abstract

BACKGROUND: Communication is a core clinical skill in medicine. In paediatrics, communication is complicated by the nature of the physician-parent-child triad and the parents' role as "gatekeeper" of information and "protector" of his/her child. Communication crises (CC) in this study are defined as interactions between families and the medical team that result in delays or obstructions in patient care and negatively impact the therapeutic relationship. OBJECTIVES: The purpose of our study was to identify, describe and characterize the types of CC that commonly occur in the pediatric inpa-tient setting. DESIGN/METHODS: Data was collected via focus groups with key informants. Key informants were individuals who experience CC firsthand or are called upon to support conflict resolution. FG proceeded through open-ended questions to explore experiences and perceptions about CC. FG were audio taped and transcribed. Data were analyzed using grounded theory and constant comparison methods. RESULTS: Data was collected via two semi-structured interviews with families (2) and seven focus groups (FG) including paediatricians (10), nurses (6), social workers (4), hospital administrators (5) and familes (2). An eighth verification focus group (6) was conducted in order to present the initial concepts and constructs from the data analysis and seek feedback from participants re our initial findings and the construct under development. This verification focus group was a mixture of health care provider types. Three major themes and associated subthemes emerged; 1) Health care team factors: care processes, interprofessional communication and individual communication skills 2) Family factors: language barriers, mental illness, belief systems and socioeconomic and 3) Patient factors: acuity, complexity, unstable condition and unclear diagnosis. The presence of a trusting relationship (TR) between the family and team is the core variable identified as critical to the communication process. CONCLUSION: CC are a complex event and this study provides an initial analysis of these types of situations. A TR between families and the team is critical in successfully navigating CC yet the inpatient setting poses unique challenges in doing so.