Quotes Representing the Core Theory, Themes, and Subthemes (Factors) Emerging From Descriptions of Communication Crises in the Pediatric Hospital Setting

Communication crises core theory: Parent Trust in HCP(s)
“When families have a deep sense of mistrust for the system, it’s a piece that’s very difficult to figure out how to bridge so that you can move forward… 1 of these underlying things that leads us into crisis more often, if not inevitably…” FG 1
“If you feel a level of trust, between you and the health care provider and they care about my child who I care about, you’ve got a mutual goal.” FG 5
“They want to have a positive outcome for their child but try dictating the next steps because they don’t trust… so just getting them to comply, believe and trust that what you’re doing is in their best interest, sometimes gets very difficult.” FG 2
“Some families tend to be more hesitant with anything that’s presented to them, it just depends on their entry into health care and what their experiences have been.” FG 2
“There’s certain cultures that do not trust what happens within this system.” FG 2
“So as long as there’s that trust level, sometimes you’re okay to wait but if there isn’t that communication and connection, then you’re not okay to wait… You just feel taken advantage of.” FG 5
Communication crises themes and subthemes (factors)
 1. Patient factors
  a. Acute condition“…the acuity of the child certainly ups the ante… it’s much quicker to get to crisis because you have to act and do what’s right for the child, so it limits the time that you can spend to figure out how to come to a common ground.” FG 1
  b. Unclear diagnosis“There was really no answer for what had caused the original infection that had brought him to hospital, so it created frustrations for the family…” FG 7
  c. Unstable condition“If there’s not great communication and the child’s clinical situation changes rapidly, it can be a challenge because you’re not only trying to address what hasn’t been going well but then it’s in the context of a change in the child’s medical condition.” FG 1
  d. Medical complexity“When you are continually involved with a patient that is long-term and you see the different teams turning over and, you know, people don’t listen to you when you say… well, we’ve tried this in the past.” FG 5
 2. Health care team factors
  e. Communication skills“It’s not just what you say but it’s how you present it… are you halfway out the door when you’re having a conversation or are you coming in and taking the time to sit down and say ‘I have time for you?’” FG 2
  f. Care processes“We work 8-hour shifts, so parents could get different messages from staff every 8 hours.” FG 7
  g. Interprofessional communication“I think there were unintended consequences of different specialists saying something the same way but using different words.” FG 1
 3. Family factors
  h. Language and cultural barriers“English was not her first language and she would only communicate via the child’s father so we were never sure that what the father was saying was actually what the mother was saying.” FG 1
  i. Socioeconomic factors“There’s always a back story and sometimes it’s a very acute kind of crisis for a family outside of this (hospitalization) such as loss of a job, a marriage breakup, besides the ill child.” FG 1
  j. Mental health conditions“If the cause for the family’s inability to move forward is from mental illness, I find that especially frustrating because often there’s not much that we can do about it as pediatricians.” FG 6
  k. Beliefs“They were very religious and had already decided very clearly that no matter what their child was like, they wanted to do everything.” FG 4