Reported contributors to communication vulnerability for adult patients in critical care

Background: Patients admitted to the intensive care unit experience communication vulnerability due to patient-factors including the use of an advanced airway to facilitate mechanical ventilation. Communication vulnerability puts patients at risk for adverse safety events and breakdowns in care. A more complete understanding of communication vulnerability that includes socio-relational and contextual factors can expose opportunities to improve patient communication and safety in the intensive care unit. Aim: To expand our understanding of patient communication vulnerability in the adult intensive care unit using a disability rights approach. Methods: We used a qualitative descriptive methodology including semi-structured interviews and paired content analysis. Between January – April 2024, 22 participants were interviewed including 11 professionally diverse healthcare providers, 7 family members, and 4 patient survivors from a community academic hospital in Toronto, Canada. Interviews were audio recorded and transcribed. Findings: Patient, family, and healthcare provider participants described often converging patient-, socio-relational-, environmental-, and structural- factors that contribute to patient communication vulnerability in the adult intensive care unit. In addition to patient factors, reported socio-relational factors included insufficient clinician communication training. Reported environmental factors included insufficent communication tool accessibility, lack of patient privacy, lighting and noise levels. Reported structural factors of communication vulnerability included family inclusion and infection control policies. Conclusions: This study presents patient, family, and healthcare provider reported contributors to patient communication vulnerability in the intensive care unit beyond patient-factors. Identifying socio-relational, environmental and structural related factors contributing to communication vulnerability provides multiple opportunities to improve patient communication practices and safety for adults in the intensive care unit. Implications for Clinical Practice: Using a disability rights approach to understanding patient communication vulnerability in the adult intensive care unit exposed socio-relational and contextual opportunities for system-based practice change. These include systemic availabilty of communication tools and conducting environmental scans of lighting and noise-levels.