Pediatric Residents' Reflections on Communicating With Families of Children With Medical Complexity: A Qualitative...

Effective communication between providers and patients/families is essential for optimal health outcomes, especially for children with medical complexity (CMC). Pediatric residents' perspectives on facilitators of and barriers to communication with families of CMC could help inform targeted approaches to training and skill development. To explore pediatric residents' reflections on facilitators and barriers of effective communication with families of CMC during clinical encounters.

We conducted a thematic analysis of semistructured interviews with senior pediatric residents. The interview guide was informed by literature review and consensus of experts, including family partners. Data collection and analysis continued iteratively until thematic sufficiency was reached. We obtained participant demographic data at the time of enrollment.

Eleven senior pediatric residents participated in this study, most of whom had previous experience in inpatient and/or outpatient complex care clinical rotations. Themes included factors affecting communication related to families of CMC (health literacy, expertise, and teaching), residents (bias, emotion, and experience), and context (distractions and time constraints in acute settings, continuity), as well as communication strategies that enable clinical partnership (humanizing, exploring incongruence, active listening, collaboration, and systematic approach). Themes aligned with constructs related to shared decision-making models.

Our findings highlight important factors that residents perceive as affecting meaningful communication with families of CMC during clinical encounters. Residents' reflections centered around opportunities to engage in shared decision-making with families as members of the care team. Communication strategies that were noted to be effective may inform future curricula to support patient/family-centered care for CMC.