Patient centered insights on communication and care: a qualitative study of obstetric sepsis risk experiences and recommendations

Patient-clinician communication is a central component of high-quality, patient-centered care and shapes how patients experience and evaluate their healthcare. Examining patient-clinician communication may therefore provide insight into disparities in severe maternal morbidity (SMM), including conditions such as obstetric sepsis. Obstetric sepsis is a leading and preventable cause of severe maternal morbidity (SMM), disproportionately impacting Black and Brown birthing people. Delayed sepsis recognition can be attributed to social drivers of health (SDoH) and poor patient-clinician communication. Given this, examining communication in the context of sepsis risk management is critical, and may help understand SMM more broadly. To address these concerns, this study uses community-based participatory research (CBPR) to understand patient birthing experiences and identify strategies to improve sepsis management and care continuity. Using the CBPR framework, we collaborated with community stakeholders to co-design study tools and recruitment strategies for qualitative interviews in English and Spanish. Participants were recruited through purposive sampling from four participating NYC hospitals. Descriptive statistics were calculated, and qualitative data was analyzed using an inductive thematic analysis approach, with codes developed and refined iteratively through team-based coding and consensus review. Qualitative findings were drawn from co-occurrence data displays, highlighting patient experiences with sepsis and infection, communication, and care recommendations. Sixty patients participated in both demographic surveys and qualitative interviews. Most identified as Black and/or Hispanic or Latina and had Medicaid insurance. Participant accounts emphasized the significance of communication as demonstrated across the five emergent themes: (1) the role of communication during sepsis and infection uncertainty; (2) communication shapes patient perceptions of care quality; (3) communication supports shared decision-making and patient autonomy; (4) communication builds trust and enables patient advocacy; and (5) patient recommendations emphasize communication, preparedness, and support. Findings revealed that quality patient-clinician communication can foster trusting relationships, manage uncertainty, support shared decision-making, and shape patient perceptions of care quality. These communication functions can impact the timely care necessary to prevent complication like sepsis. Future research should apply CBPR approaches in clinical obstetric settings to further understand how communication impacts perinatal health outcomes and ways to institutionally monitor communication as a clinical metric.