Perspectives on Implementing a Communication Facilitator Intervention From a Critical Care Setting.

Abstract

Context: Critically-ill patients and their families often experience communication challenges during their ICU stay and across care transitions. An intervention using communication facilitators may help address these challenges.

Objectives: Using clinicians' perspectives, we identified facilitators and barriers to implementing a communication intervention.

Methods: Using purposive sampling, we conducted semi-structured interviews with 17 clinicians from an intensive care unit at an academic health center that participated in a randomized trial of communication facilitators. We used the Consolidated Framework for Implementation Research (CFIR) to guide data collection and analysis.

Results: CFIR constructs of relative advantage, communication, and critical incidents facilitated the intervention's implementation. CFIR constructs of access to knowledge and information, relational connections, and clinician knowledge and belief hindered its implementation. Clinicians reported that facilitators provided continuity to patients and families, support in a trusting and proactive manner over transitions of care, and bridged communication between families and clinicians particularly during the Covid-19 pandemic. Limited information about the intervention prevented clinicians from working with facilitators earlier in the course of the intervention. Differences in beliefs regarding facilitator involvement during family meetings also hampered the intervention's implementation.

Conclusions: Future studies should incorporate implementation strategies that help connect facilitators to clinicians early in the intervention period which may improve role clarity and enhance collaboration.