Core dimensions of difficult communication in clinical encounters, their intersectionality, and affecting factors

Background: Difficult communications in clinical encounters are ubiquitous among professionals with different scope of practice and in diverse care settings. Obstacles are largely recognized but how they are intertwined and influence the healthcare professionals’ concept of difficult communication is not known. Aim/Research question or hypothesis: To describe the core dimensions of difficult communication and their intersectionality as self-perceived by professionals with varying care roles in different care contexts. Factors influencing the dimensions were also examined. Methods: Overall, 165/675 (24.4%) professionals completed an online survey. The questionnaire assessed what professionals mean by difficult communication (multiple choices) and four core dimensions were defined based on the answers to the question “What do you think difficult communication means?”: 1) emotional (accommodating patient, family or professional emotions); 2) cognitive (dealing with patient and/or family limited awareness of prognosis or disease trajectory); 3) behavioural (confronting aggressive, unbeneficial care preferences or unrealistic expectations); and 4) physical or cultural barriers. Sociodemographic data were also collected. Results: 73%, 71% and 69% of the respondents indicated the emotional, behavioural and cognitive dimension individually or combined with other(s), respectively. Only 38% reported the barriers dimension. Female reported the cognitive dimension more frequently than male (72% vs 50%, p=0.029) and those identifying the cognitive dimension often reported the behavioral one (78% vs 55%, p=0.002). Moreover, professionals signaling the behavioral dimension more commonly pointed the barriers dimension (46% vs 17%, p<0.001). The working experience in the current care setting influenced the barriers dimension perception (p<0.001). No difference in the core dimensions emerged according to the scope of practice. Discussion: Identifying what professionals mean with difficult communication and which factors may influence their perception may help to tailor the content of educational interventions to sustain their engagement in clinical communication encounters.