Opportunities and threats to communication and relationships with patients and patients' loved ones along an intensive care unit journey: a qualitative journey mapping study.

Purpose: When a patient requires critical care, the patient and their loved ones embark on a complex and challenging journey through the intensive care unit (ICU). Communication and the development of trusting relationships is an important part of the journey, especially within the paradigm of patient- and family-centred care (PFCC). We sought to expand our understanding of opportunities and threats to communication, trust, and relationship-building throughout the ICU journey from the perspectives of patients, their loved ones, and ICU health care providers.

Methods: We conducted semistructured journey-mapping interviews with 18 participants, including ICU health care providers (n = 10), patients (n = 4), and their loved ones (n = 4). In collaboration with 2 patient partners, we used directed content analysis to identify and understand opportunities and threats.

Results: Using the building blocks of the ICU journey, we identified opportunities and threats that could enhance or disrupt relationships, trust, and communication. Opportunities included actions that the ICU team can take to enhance the journey (e.g., providing predictable, consistent, timely, clear, concise, and digestible information to patients and/or loved ones). Threats included factors inherent to the ICU experience (e.g., patients being unable to communicate, the physical and psychological ICU environment), systemic factors (e.g., limited health human resources), and ineffective communication and/or inaction on the part of the ICU team (e.g., limited consideration for patient and loved ones' decisions, goals, privacy, and/or autonomy).

Conclusions: Opportunities provide actionable steps that can be taken to enhance PFCC, while threats include inaction and factors inherent to the ICU that are more difficult to mitigate.