Trust of inpatient physicians among parents of children with medical complexity: a qualitative study

Tammie Dewan; Andrea Whiteley; Lyndsay Jerusha MacKay; Rachel Martens; Melanie Noel; Chantelle Barnard; Isabel Jordan; Anne Janvier; Sally Thorne

doi:10.3389/fped.2024.1443869

Trust of inpatient physicians among parents of children with medical complexity: a qualitative study

Front Pediatr. 2024 Sep 27:12:1443869. doi: 10.3389/fped.2024.1443869. eCollection 2024.

Authors

Tammie Dewan^#^{1

2}, Andrea Whiteley^#¹, Lyndsay Jerusha MacKay³, Rachel Martens^{4

5}, Melanie Noel⁶, Chantelle Barnard^{1

2}, Isabel Jordan⁷, Anne Janvier^{8

9}, Sally Thorne¹⁰

Affiliations

¹ Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
² Section of Pediatric Hospital Medicine, Alberta Children's Hospital, Calgary, AB, Canada.
³ School of Nursing, Trinity Western University, Langley, BC, Canada.
⁴ Canchild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.
⁵ Azrrieli Accelerator, University of Calgary, Calgary, AB, Canada.
⁶ Department of Psychology, University of Calgary, Calgary, AB, Canada.
⁷ Independent Researcher, Squamish, BC, Canada.
⁸ Division of Neonatology, Research Center, Unité d'éthique Clinique, Bureau du Partenariat Patients-Familles-Soignants, CHU Sainte-Justine, Montréal, QC, Canada.
⁹ Department of Pediatrics, Bureau de l'éthique clinique (BEC), Université de Montréal, Montréal, QC, Canada.
¹⁰ School of Nursing, University of British Columbia, Vancouver, BC, Canada.

^# Contributed equally.

Abstract

Background: Trust is a foundation of the therapeutic relationship and is associated with important patient outcomes. Building trust between parents of children with medical complexity (CMC) and physicians during inpatient care is complicated by lack of relational continuity, cumulative (sometimes negative) parent experiences and the need to adjust roles and expectations to accommodate parental expertise. This study's objective was to describe how parents of CMC conceptualize trust with physicians within the pediatric inpatient setting and to provide recommendations for building trust in these relationships.

Methods: Interviews with 16 parents of CMC were completed and analyzed using interpretive description methodology.

Results: The research team identified one overarching meta theme regarding factors that influence trust development: situational awareness is needed to inform personalized care of children and families. There were also six major themes: (1) ensuring that the focus is on the child and family, (2) respecting both parent and physician expertise, (3) collaborating effectively, (4) maintaining a flow of communication, (5) acknowledging the impact of personal attributes, and (6) recognizing issues related to the healthcare system.

Discussion: Many elements that facilitated trust development were also components of patient- and family-centered care. Parents in this study approached trust with inpatient physicians as something that needs to be earned and reciprocated. To gain the trust of parents of CMC, inpatient physicians should personalize medical care to address the needs of each child and should explore the perceptions, expertise, and previous experiences of their parents.

Keywords: hospital; medical complexity; parents; patient- and family-centered care; pediatrics; physician; relationship; trust.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The research team was awarded funding from Norman Saunders Complex Care Initiative at the Hospital for Sick Children Foundation in Toronto, ON, Canada.