When Differing Perspectives Between Health Care Providers and Parents Lead to “Communication Crises”: A Conceptual Framework to Support Prevention and Navigation in the Pediatric Hospital Setting

Abstract

OBJECTIVES: The communication experience and therapeutic relationships between parents and health care providers (HCPs) impacts the quality of patient care. A guiding “communication crisis” description was created to encourage study participants to describe difficult communication encounters between parents and HCPs where their perspectives regarding the recommended patient care conflicted (ie, parent refusal of a lumbar puncture), which created barriers to the provision of optimal care and the development of therapeutic relationships in the pediatric hospital setting. The purpose of this research was to highlight factors that may contribute to communication crises through the characterization of these circumstances. METHODS: Participants were multidisciplinary HCPs and parents (n = 37) with firsthand experience regarding communication crises. Data were collected through focus groups (7), semistructured interviews (2), and a verification focus group where open-ended questions regarding participants’ experiences were used. Data were analyzed by using a constructivist grounded theory approach. RESULTS: Three themes and 11 subthemes (communication crisis risk factors) were identified: (1) health care team factors (communication skills, care processes, and interprofessional communication), (2) family and/or parent factors (language or cultural barriers, mental health conditions, socioeconomic factors, and beliefs), (3) patient factors (acute condition, unclear diagnosis, unstable condition, and medical complexity). A core theory emerged: parent trust in their HCP significantly impacts the therapeutic relationship and can mitigate communication crises despite the presence of risk factors. CONCLUSIONS: We highlight factors that may be predisposing to communication crises in pediatric hospital settings. Awareness of these factors can support timely identification and implementation of relationship care and foster the establishment of trusting relationships.