"Listening Neglect": A Mixed-Methods Study of How Families Feel Unheard in Hospitals

Listening is essential for communication and is a key driver of patient safety. We aimed to gain a rich understanding of how hospitalized patients and families feel unheard to develop actionable interventions.

This mixed-methods study examined data from family safety interviews administered to hospitalized patients and families on pediatric inpatient units of 8 US hospitals. We coded comments pertaining to the feeling unheard theme and developed subthemes using inductive thematic analysis. Reviewer pairs independently coded responses and resolved discrepancies through consensus. Fisher exact and χ2 tests compared characteristics of those reporting feeling unheard vs their counterparts.

Overall, we interviewed 1375 patients and families and identified 115 reports of feeling unheard. Subthemes of feeling unheard included: (1) disrespectful behavior from staff across disciplines; (2) dismissive attitudes toward patient preferences, concerns, questions, and symptoms; (3) failing to use interpretation and translation services, including when requested by families; (4) underdelivering on promises; (5) inflexibility in applying policies; and (6) families repeating or escalating concerns to be heard. Patients themselves and parents/caregivers with a college education were more likely to report feeling unheard. We coined the term "listening neglect" to describe the experience of feeling unheard in hospitals.

Staff across disciplines exhibited behaviors in making patients and families feel unheard, including disrespect, dismissive attitudes, underutilization of interpretation and translation, underdelivering on promises, inflexibility, and requiring families to escalate concerns to be heard. Hospital systems-level and clinician-level interventions are needed to address staff burnout and promote active listening, effective communication, and patient and family-centered care.