717 - Functions of Communication During Emergency Care of Children with Medical Complexity: Caregiver Perspectives

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 717
Publication Number: 717.105

Julia A. Ciurria, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Jennifer Reyes Lin, Washington University in St. Louis School of Medicine, St louis, MO, United States; Cassandra Pruitt, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Bryan A. Sisk, Washington University School of Medicine, Saint Louis, MO, United States

Presenting Author(s)

Julia A. Ciurria, MBBCh (she/her/hers)

Clinical Fellow, Division of Emergency Medicine
Washington University in St. Louis School of Medicine
St. Louis, Missouri, United States

Background: Communication in the emergency department (ED) is key to ensuring patient safety and providing high-quality care. Communication in the ED poses unique challenges due to acuity, time constraints, and patient volume. These challenges are compounded during emergency care of children with medical complexity (CMC), leaving this population particularly vulnerable to communication breakdowns. A functional communication model has been established in other fields, such as pediatric oncology, but to date there have been no studies to evaluate communication experiences of caregivers of CMC while in the ED.

Objective:

To identify caregiver perspectives on communication functions during emergency care of CMC.

Design/Methods:

We conducted 15 semi-structured interviews with caregivers of CMC within 6 months of an ED visit. Thematic analysis was performed using a functional communication model as an a priori framework.

Results:

All 8 core functions of communication from the previously established framework were identified in this population. “Building relationships” manifested as providers demonstrating clinical competency, attentiveness, and an understanding of the unique challenges faced by caregivers of CMC. “Exchanging information” included providers clearly identifying their role and explaining next steps to the caregiver. Caregivers overwhelmingly valued providers who would “check in” with them frequently, even when new information was not available. “Enabling self-management” often involved conversations with the pediatrician on strategies to avoid ED visits. “Providing validation” included recognizing caregivers as the expert of their own child. “Responding to emotions” included addressing caregivers’ concerns, offering reassurance, and de-escalating emotions. “Managing uncertainty” involved discussing disposition to allow for caregiver planning. “Making decisions” and “supporting hope” were the least commonly described functions and were most often discussed in reference to goals of care. Almost all caregivers described ED visits as unexpected and frightening experiences.

Conclusion(s):

Analysis of interviews with caregivers of CMC regarding communication in the ED has demonstrated that a previously established functional model of communication is valid in this population. This framework can serve to help providers better understand the communication needs of caregivers of CMC during emergency care. Future work should aim to 1) measure outcomes related to these communication functions and 2) identify provider perspectives on communication functions, both of which would improve overall care of CMC while in the ED.