Ciurria Julia A, Lin Jennifer Reyes, Pruitt Cassandra M, Sisk Bryan A
Department of Pediatrics, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
Department of Emergency Medicine, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave, Campus Box 8072, St. Louis, MO 63110, USA.
Patient Educ Couns. 2025 May;134:108667. doi: 10.1016/j.pec.2025.108667. Epub 2025 Jan 14.
We investigated communication experiences of caregivers of children with medical complexity (CMC) during emergency care.
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.
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.
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.
This communication framework can support ED clinicians in better understanding the communication needs of caregivers of CMC during emergency care.
我们调查了患有复杂疾病儿童（CMC）的照料者在急诊护理期间的沟通经历。
15名CMC的照料者参与了关于在急诊科（ED）为其孩子寻求护理时沟通情况的半结构化访谈。采用先前建立的功能性沟通模型作为先验框架进行主题分析。
在这一群体中确定了先前确立的8项沟通核心功能中的每一项。“建立关系”表现为临床医生征求照料者的意见并回应照料者的需求。“交换信息”包括向照料者清楚地解释后续步骤。“回应情绪”承认寻求急诊护理时固有的痛苦。“提供认可”包括认可照料者是其自己孩子的专家。“促进自我管理”表现为确定照料者的需求并引导其获取资源。“做出决策”表现为让照料者参与决策过程并认识到照料者的决策疲劳。“管理不确定性”包括与照料者制定计划。“支持希望”是描述最少的功能，表现为强调孩子病情的积极方面。许多照料者描述了负面的沟通经历，即他们的担忧和见解未被听取或被忽视。
CMC的照料者描述的沟通经历和目标与在其他严重儿童疾病中确定的8项沟通功能一致，只是具体实施方式有所不同。
这一沟通框架可支持急诊科临床医生更好地理解CMC的照料者在急诊护理期间的沟通需求。
