Functions of communication during emergency care of children with medical complexity: Caregiver perspectives

Objective: We investigated communication experiences of caregivers of children with medical complexity (CMC) during emergency care.

Methods: Fifteen caregivers of CMC participated in semi-structured interviews regarding communication while seeking care for their child in the emergency department (ED). Thematic analysis was applied using a previously established functional communication model as an a priori framework.

Results: Each of the previously established 8 core functions of communication were identified in this population. "Building relationships" manifested as clinicians soliciting caregiver input and responding to the needs of the caregiver. "Exchanging information" included clearly explaining next steps to caregivers. "Responding to emotions" acknowledged the inherent distress of seeking emergency care. "Providing validation" included recognizing caregivers as the expert of their own child. "Enabling self-management" manifested as identifying caregiver needs and directing toward resources. "Making decisions" manifested as involving caregivers in the decision-making process and recognizing caregiver decision fatigue. "Managing uncertainty" involved developing plans with caregivers. "Supporting hope" was the least commonly described function and manifested as emphasizing positive aspects of a child's condition. Many caregivers described negative communication experiences in which their concerns and insights were unheard or invalidated.

Conclusion: Caregivers of CMC described communication experiences and goals that align with 8 communication functions that were identified in other serious childhood illnesses with unique operationalizations.

Practice implications: This communication framework can support ED clinicians in better understanding the communication needs of caregivers of CMC during emergency care.