P2.B027: Barriers to successful patient and family communication in a cardiac care unit

Background: Communication between clinicians and patients/families is a critical aspect of effective healthcare delivery and may be more challenging in the face of cultural differences, language barriers, and differences in health literacy. Challenges in communication may be magnified in the setting of complex inpatient congenital heart disease (CHD) care. Communication challenges can result in misunderstanding of the condition/treatment and potentially lead to mistrust of the medical team. This study focuses on understanding communication dynamics and preferences in the inpatient setting for individuals with CHD, their families, and their clinicians.

Methods: This is a cross-sectional, mixed-methods study which included surveys and one-on-one interviews. The study included patients 18 years old and family members 18 years old of any patient being cared for in a cardiac care unit, who spoke either English or Spanish. A survey of communication experience and preferences was administered, and all participants were invited to take part in a semi-structured interview to gain greater insight. Clinicians who cared for cardiac patients, regardless of specialty, were eligible for participation in interviews. Interviews were transcribed and thematically coded for prominent themes.

Results: A total of 27 parents from 20 different families completed surveys, with 17(63%) female, 10(37%) White Non-Hispanic, and 7(26%) Spanish speaking or bilingual.
Of the 27 who completed surveys, 5(19%) participated in a one-on-one interview. Three clinicians also participated in one-on-one interviews. Overall, 20(74%) agreed/strongly agreed (A/SA) that they could explain their child’s medical condition to others. Additionally, 5/26(19%) A/SA with experiencing situations where cultural differences influenced their interactions with the health care team, 5/26(19%) A/SA with language barriers impacting their understanding of medical information ,7(26%) A/SA with having times when their concerns/questions were not adequately address by the team, and 9(33%) A/SA with having times when the team did not understand their wants and needs. Five(31%)of the minority race/ethnicity reported A/SA for cultural and language barriers compared to 0(0%) non-minority. Similarly, 2(33%) Non-English speaking/Bilingual individuals reported A/SA for language barriers and 3(43%) for the team not understanding wants and needs compared to 3(15%) and 6(30%) of English speaking respectively. These differences did not reach statistical significance. (Table 1)

Predominant themes from the interview grouped into 3 major categories: 1)Clinician and health system, 2)Patient and family, 3)Power dynamics. Across all of these categories, potential challenges to effective communication were revealed as well as the fact that language barriers and cultural differences have the potential to exacerbate these challenges. (Figure 1)

Conclusion: Successful communication in the complex care setting is frequently achieved but can be challenging. Those of minority status and with primary languages other than English appear to be at heightened risk for less successful communication. Further work is needed to identify and test individually tailored communication strategies.