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.

Study Overview

• Status: Not yet recruiting
• Conditions: Communication Barriers

Detailed Description

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.

• Study Type: Observational
• Enrollment (Estimated): 100

Contacts and Locations

• Study Contact: Name: Jason Chui, MBChB, FRCPC; Phone Number: 66378 604-875-4111; Email: jason.chui@ubc.ca
• Study Contact Backup: Name: Shirley Lim, BSN, BS-HRIM; Email: shirley.lim@vch.ca

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V5Z 1M9
      • Vancouver General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Care givers to the non-verbal patients with communication barrier

Description

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

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
High-priority Communication Needs in Acute Care	Communication needs identified as high priority by healthcare providers based on their ratings of the importance and frequency of communication needs experienced by patients with impaired verbal communication in acute care settings. The survey will also assess which communication functions healthcare providers consider most important for inclusion in future assistive communication interfaces.	At completion of the 3-5-minute survey on Day 1
Priority of Communication Needs in Acute Care	Healthcare providers' ratings of the importance and frequency of communication needs experienced by patients with impaired verbal communication in acute care settings. Priority communication needs will be identified through thematic analysis of interviews and quantified in the Stage 2 survey using importance and frequency ratings.	Stage 1 interviews and Stage 2 survey; approximately Months 3-4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Current Communication Strategies and Perceived Limitations	Identification and characterization of communication strategies currently used by healthcare providers, including low-technology and augmentative and alternative communication approaches, and perceived limitations or barriers associated with their use. Findings will be derived from qualitative interviews and summarized quantitatively in the survey where applicable.	Stage 1 interviews and Stage 2 survey; approximately Months 3-4
Priority Communication Functions for Bedside Use	Healthcare providers' prioritization of communication functions considered most appropriate for a simplified bedside assistive communication interface. Participants will select a limited number of communication functions from those identified during the qualitative phase.	Stage 2 survey; approximately Month 4
Workflow and Implementation Feasibility Requirements	Healthcare providers' perceptions of practical requirements for implementing assistive communication tools in acute care, including acceptable setup time, training requirements, workflow integration, and environmental or clinical barriers.	Stage 1 interviews and Stage 2 survey; approximately Months 3-4

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Communication System Functional Requirements	Identification of functional and interface requirements for future assistive communication systems, including required communication tasks, presentation/interface considerations, contextual information, and usability requirements. Requirements will be identified through thematic analysis and prioritized using survey findings.	Stage 1 interviews and Stage 2 survey; approximately Months 3-4

Collaborators and Investigators

• Sponsor: University of British Columbia
• Collaborators: Vancouver General Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: July 28, 2026
• First Submitted That Met QC Criteria: August 27, 2026
• First Posted (Actual): August 31, 2026

Study Record Updates

• Last Update Posted (Actual): August 31, 2026
• Last Update Submitted That Met QC Criteria: August 27, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: mechanical ventilation; spinal cord injury; survey; tracheostomy; communication barrier
• Additional Relevant MeSH Terms: Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Trauma, Nervous System; Spinal Cord Diseases; Spinal Cord Injuries
• Other Study ID Numbers: H26-01406

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: This study involves survey data only. Additional approval is required to share the data.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No