(786) Needs Assessment of Patient-Provider Communication and Understanding in Acute Respiratory Failure

Introduction: There are many challenges to effective communication around acute respiratory failure (ARF) in the pediatric intensive care unit (PICU). Knowing the needs of patients/families and challenges that can impact understanding can better equip providers to more effectively communicate and promote better understanding of illness and support, higher quality decisions, and greater satisfaction with care for patients and families, particularly for those with limited heath literacy or English proficiency.

Methods: Using purposeful sampling, we performed a needs assessment through a series of interviews with PICU physicians and respiratory therapists to describe needs and goals of communication around ARF. Providers were asked their opinions on what patients/families need to know about ARF and respiratory supports, challenges to communication and understanding, and how information could be presented in visual or written form to mitigate challenges and improve communication and understanding. Qualitative themes were identified to inform the development of a novel tool to aid in these conversations.

Results: Since June 2024, 8 providers (4 physicians and 4 respiratory therapists across four institutions) were interviewed. Identified themes around goals of communication included describing: cause of ARF, expected clinical course (progression of illness and recovery), need for interventions, and how interventions would treat ARF. Identified challenges to communication and understanding for patients/families included: stress of hospitalization and limited bandwidth, language barriers, limitations in health literacy, prior experiences with health systems, and medical distrust. Characteristics of an ideal tool to assist in these conversations were: predominantly visual, depicting basic respiratory anatomy and the spectrum of respiratory supports, interfaces, and equipment.

Conclusions: Medical providers believe effective communication around ARF must incorporate a combination of description of the disease process and trajectory and a description of respiratory supports and their function. Additional interviews with patients/families are ongoing and will help further delineate needs and challenges to understanding. A visual tool informed by this needs assessment will be developed and studied in ARF conversations.