Understanding Communication Barriers in Acute Care: A Mixed-Methods Needs Assessment Among Healthcare Providers Caring for Non-Verbal Patients With Spinal Cord Injury and Tracheostomy in the ICU

Understanding Communication Barriers in Acute Care: A Mixed-Methods Needs Assessment Among Healthcare Providers Caring for Non-Verbal Patients With Spinal Cord Injury and Tracheostomy in the ICU

Communication impairment is common among critically ill patients who are mechanically ventilated, have tracheostomies, or have neurological injuries such as spinal cord injury. In acute care settings, inability to communicate contributes to patient distress, impairs symptom assessment, and may delay care. Although a range of communication supports exist, many are difficult to use in patients with severe weakness, limited endurance, or fluctuating cognition. More advanced assistive communication systems, including eye-tracking and brain-computer interface platforms, have shown promise in chronic neurological populations but have not been well adapted to the practical realities of acute care.

This study will use a sequential exploratory mixed-methods design to better understand communication barriers in acute care from the perspective of frontline healthcare providers. In the qualitative phase, semi-structured interviews will be conducted with nurses and speech-language pathologists working with patients who have spinal cord injury, tracheostomy, or other causes of impaired verbal communication in ICU and related acute care settings. Findings from these interviews will inform development of a structured survey to be distributed to a broader group of nurses and speech-language pathologists. Qualitative and quantitative findings will then be integrated to identify priority communication needs, limitations of current strategies, and practical requirements for future assistive communication tools. Findings will inform development of clinically relevant communication solutions for acute care environments.

This study will employ a two-stage sequential exploratory mixed-methods design. In the first stage, semi-structured interviews (N=10-15) and, where feasible, focus groups will be conducted with ICU clinicians and rehabilitation staff to identify communication barriers and priority use cases for assistive communication in nonverbal patients. Themes emerging from qualitative analysis will inform the development of a structured survey, which will be administered to a broader cohort of clinical staff (N=80-100) to quantify the prevalence and relative importance of identified communication gaps. Findings from the qualitative and quantitative phases will be integrated to generate a clinical requirements framework to inform the future development of assistive communication tools for acute care settings.

Inclusion Criteria:

• be a healthcare provider such as physicians, registered nurses, speech-language pathologists, occupational therapists, or physiotherapists;
• work in ICU, spine, neurosurgical, or related acute care inpatient settings;
• have experience caring for patients with impaired verbal communication, including patients with tracheostomy, mechanical ventilation, or spinal cord injury; and
• be able to provide informed consent. A small subset of family caregivers may also be included if they have direct experience supporting communication for patients with impaired verbal communication in these settings.

Exclusion Criteria:

• Individuals not directly involved in the care of patients with impaired verbal communication in the relevant clinical settings
• Trainees who are not yet independently practicing, unless they are participating in an independent clinical role
• Family caregivers without direct experience supporting communication needs in the acute care setting