ABSTRACT
Background
The COVID‐19 pandemic accelerated digital communication adoption in intensive care units when traditional bedside visits became restricted. Understanding multi‐stakeholder satisfaction with digital communication is essential for optimizing family‐centred care in the post‐pandemic era.
Aim
To examine satisfaction with digital communication among physicians, nurses and families in intensive care units, identify influencing factors and analyse implications for practice.
Study Design
A cross‐sectional study using purposive sampling was conducted from August 2023 to May 2024 in intensive care units at a medical center in Taiwan.
Results
In total, 300 participants (100 physicians, 100 nurses, and 100 family members) participated in this study. Family members reported significantly higher satisfaction (mean 84.6, 95% CI: 82.4–86.8) than physicians (mean 80.6, 95% CI: 78.5–82.7) and nurses (mean 77.8, 95% CI: 75.2–80.5). Communication perception was the strongest predictor of satisfaction (β = 0.34, p < 0.001), explaining 34.0% of variance. Nurses scored significantly higher on communication regulations than physicians (F = 3.39, p = 0.035) and uniquely identified privacy concerns (10 mentions), workload issues and team coordination challenges.
Conclusion
Communication perception is the primary determinant of digital communication satisfaction across all stakeholder groups. Nurses demonstrated significantly lower satisfaction and unique concerns regarding workload, privacy and team coordination, requiring targeted institutional support. Optimizing ICU digital communication requires integrated strategies addressing communication quality, workforce support and organizational infrastructure.
Relevance to Clinical Practice
Healthcare institutions should implement empathetic communication training focussed on positive attitudes (the most valued factor across all groups), establish dedicated communication staff to reduce nurse workload burden, address technical infrastructure barriers (the most frequently cited concern), develop clear protocols for privacy protection and workflow integration and provide simplified medical explanations to enhance family comprehension in ICU digital communication.
Keywords: communication, critical care nursing, digital communication, family‐centered care, patient satisfaction, telemedicine
Impact Statement
- What is known about this topic?
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○The COVID‐19 pandemic accelerated digital communication adoption in intensive care units, yet satisfaction across multiple stakeholder groups remains poorly understood.
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○Previous research has focussed primarily on single stakeholder perspectives, limiting comprehensive understanding of digital communication effectiveness.
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○Nurses face unique challenges balancing digital communication demands with direct patient care.
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- What this paper adds?
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○Multi‐stakeholder comparison reveals family members report higher satisfaction than healthcare providers, with communication perception as the primary determinant across all groups.
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○Nurses demonstrate lower satisfaction and unique concerns regarding workload, privacy and team coordination that require targeted institutional support.
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○Evidence‐based strategies including empathetic communication training, technical support, clear protocols and health literacy enhancement can optimize digital communication effectiveness.
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1. Introduction
Communication between healthcare providers and patients' families in intensive care units (ICUs) is challenging. Critically ill patients are often unable to communicate independently, and healthcare providers must convey medical information, explain treatment plans and facilitate decision‐making with families. The high‐pressure ICU environment, complex information and time constraints frequently impede effective communication.
The COVID‐19 pandemic accelerated the use of digital communication tools (e.g., mobile calls, video calls, instant messaging) to maintain family connections during visitation restrictions [1]. These technologies have remained essential in ICU communication beyond the pandemic, improving the immediacy and accessibility of medical information [2]. However, the pandemic also exposed significant challenges in communicating with families living in complete isolation [3]. Research has demonstrated that although video calls are feasible for end‐of‐life communication and family support during isolation, they cannot fully replace in‐person presence and require structured communication strategies and emotional support to be effective [3, 4]. This tension between the necessity and limitations of digital communication underscores the need to understand stakeholder experiences and satisfaction in the post‐pandemic context.
Digital communication presents both opportunities and challenges for ICU care. Although physicians perceive it as efficient for information delivery [5, 6], the lack of non‐verbal cues complicates assessing family understanding, particularly during emotionally sensitive discussions such as changes in patient condition or treatment decisions [5]. Nurses, who often serve as primary communication coordinators, face challenges balancing digital communication demands with direct patient care responsibilities [7]. Technical barriers, limited device availability, network delays and unclear communication regulations further compromise communication quality and trust across all stakeholder groups [8, 9].
Different stakeholders hold varying perspectives on digital communication. Physicians (referring to medical doctors, including residents and attending physicians working in ICU settings) value its efficiency yet remain concerned about interaction depth [5, 6]. Nurses recognize the benefits but face increased workload and acknowledge that digital tools cannot fully replace face‐to‐face emotional presence [9]. Family members prioritize transparency and timely information to better understand patient conditions and participate in care decisions [8]. These differences highlight distinct needs and expectations across roles and underscore the importance of effective communication coordination [7, 10].
Despite growing use of digital communication in ICUs, research has focused primarily on technology implementation rather than stakeholder experiences and perceptions. Few studies have examined satisfaction differences among physicians, nurses and family members or identified factors influencing digital communication satisfaction across these groups.
1.1. Aims
This study aimed to: (1) compare digital communication satisfaction among physicians, nurses and family members in ICUs; and (2) identify factors associated with satisfaction across groups.
2. Design and Methods
2.1. Study Design
This descriptive cross‐sectional study examined satisfaction with digital communication among physicians, nurses and family members in intensive care units. The study was conducted from August 2023 to May 2024 and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement [11].
2.2. Setting and Sample
This study was conducted at a tertiary medical centre in northern Taiwan with approximately 164 acute intensive care beds across multiple units, including medical, surgical, cardiovascular and neurological ICU.
Purposive sampling was used to recruit physicians, ICU nurses and family members with experience in digital communication regarding critically ill patients. To minimize selection bias, consecutive eligible individuals were approached by the principal investigator across all ICU units during the study period. To ensure independence of observations, only one family representative was enrolled per patient. After obtaining informed consent, participants completed paper‐based questionnaires on‐site, which were immediately collected. A small monetary incentive (approximately 3 USD) was provided.
Inclusion criteria were (a) for healthcare providers: ICU physicians or nurses with experience in digital communication with families; (b) for family members: designated family contact who had engaged in digital communication with ICU staff; and (c) for patients: ICU stay ≥ 48 h and mechanically ventilated. Exclusion criteria included inability to read or write Traditional Chinese (Mandarin) and cognitive impairment preventing informed consent.
Research team members visited each ICU daily to identify eligible participants. To prevent duplicate enrolment, a confidential log was maintained and family members were asked whether they had previously participated. After obtaining written informed consent, participants completed self‐administered questionnaires in Traditional Chinese.
Sample size was calculated using Cohen's conventions for medium effect size (F = 0.25) in three‐group comparison (α = 0.05, power = 0.80), indicating at least 159 participants required [12]. For regression analysis, Green's criteria indicated at least 108 participants needed for four predictors [13].
2.3. Digital Communication Context and Operations
Digital communication was defined as technology‐mediated communication between healthcare providers and family members, including: (1) mobile phone calls and text messages; (2) instant messaging applications (primarily LINE); and (3) video calls via smartphones or tablets, rather than traditional hospital telephones or electronic health record systems.
Digital communication was implemented to supplement, rather than replace, faceto‐face interactions, particularly when in‐person visitation was restricted or when family members faced geographical or time constraints.
Communication could be initiated by either healthcare providers or family members. Physicians typically communicated regarding critical medical decisions and significant changes in patient condition, whereas nurses handled routine updates and care coordination. Family members could initiate contact through designated hospital phone numbers or LINE messaging groups.
The hospital provided institutional mobile devices, and individual ICU units established LINE groups for family communication. Although no formal institutional guidelines governed digital communication protocols, units developed informal practices regarding response timing and content. Digital communications were typically deleted when patients transferred out and were not systematically documented in the electronic health record, though clinically significant information was recorded at providers' discretion.
Digital communication was used strategically: routine matters were handled digitally, while emotionally sensitive discussions and complex decisions were preferentially conducted in person when feasible.
2.4. Data Collection Tools and Methods
The self‐administered questionnaire comprised five sections:
Demographics: For healthcare providers: sex, age, years of ICU experience, education level and professional rank. For family members: sex, age, education level and relationship to the patient.
Digital Communication Experience: Telephone and mobile calls were included as they represent synchronous digital audio transmission, which remained a primary mode of family interaction during the study period. Types of communication tools used, frequency of digital interactions, topics discussed (e.g., medical condition updates, medical document signing, follow‐up care arrangements, family support, health education, daily living needs) and preferred communication modality (face‐to‐face only, digital only or hybrid approach).
Overall Satisfaction: A single‐item numerical rating scale (0–100) provided a global measure of satisfaction with digital communication, where 0 = completely dissatisfied and 100 = completely satisfied.
Healthcare Provider and Family Bidirectional Digital Communication Scale (HF‐BDCS): This validated 13‐item instrument specifically assesses digital communication in ICU settings [14]. The scale comprises three domains: Communication Efficiency and Quality (6 items), Communication Perception (5 items) and Communication Regulations (2 items). Items are rated on a 5‐point Likert scale, yielding total scores from 13 to 65, with higher scores indicating better communication quality. The HF‐BDCS demonstrated excellent content validity (S‐CVI/Ave = 0.98–1.00), a stable three‐factor structure explaining 64.53% of variance and good internal consistency (Cronbach's α = 0.80–0.86) across participant types [12]. In the current study, the HF‐BDCS maintained strong reliability across the three groups (physicians: α = 0.82, nurses: α = 0.86, family members: α = 0.80).
Open‐Ended Feedback: At the end of the questionnaire, participants were invited to provide written comments or suggestions regarding digital communication. Responses were reviewed and categorized into common themes by the research team.
2.5. Data Analysis
Data were analysed using SPSS 26.0. Descriptive statistics summarized participant characteristics. One‐way ANOVA with Scheffé post hoc tests compared HF‐BDCS scores among groups. Stepwise multiple linear regression identified predictors of satisfaction using continuous variables (age and HF‐BDCS domain scores). Statistical significance was set at p < 0.05. Open‐ended responses were analysed using inductive content analysis.
2.6. Ethical and Institutional Approvals
This study was approved by an institutional review board (approval date: October 4, 2022; approval number: 202207043RINC) and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent.
2.7. Use of AI and AI‐Assisted Technologies in the Writing Process
During the preparation of this manuscript, the authors used Claude AI (Anthropic) for initial language translation and drafting assistance. Subsequently, the manuscript was reviewed and refined by a professional language editing service to ensure academic accuracy and linguistic flow. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article.
3. Results
3.1. Participant Characteristics and Digital Communication Experience
A total of 309 individuals were approached during the study period (103 physicians, 103 nurses and 103 family members). All physicians and nurses agreed to participate, whereas 9 family members declined, resulting in a final sample of 300 participants (100 physicians, 100 nurses and 100 family members; overall response rate: 97.1%). All participants completed valid questionnaires with no missing data.
Physicians were predominantly male (79%; mean age: 29.6 years; mean experience: 4.4 years), whereas nurses were predominantly female (91%; mean age: 37.5 years; mean experience: 14.8 years). Family members' mean age was 50.7 years; they were mainly adult children of patients (62%).
All groups primarily used mobile phones for communication, with physicians and family members favouring phone calls (92% and 83%, respectively) and nurses preferring instant messaging applications (primarily LINE, 89%). The physicians most often used digital communication for medical condition discussions, nurses for document signing and family members for condition updates. Most participants preferred combining digital and face‐to‐face communication (physicians: 72%; nurses: 49%; families: 82%). Family members reported significantly higher satisfaction (mean 84.6, 95% CI: 82.4–86.8) than physicians (mean 80.6, 95% CI: 78.5–82.7) and nurses (mean 77.8, 95% CI: 75.2–80.5) (Table 1).
TABLE 1.
Participant demographics and digital communication experience.
| Variables | Physicians (n = 100) | Nurses (n = 100) | Family members (n = 100) |
|---|---|---|---|
| Demographics | |||
| Gender, n (%) | |||
| Male | 79 (79) | 9 (9) | 55 (55) |
| Female | 21 (21) | 91 (91) | 45 (45) |
| Age, mean (SD) years | 29.6 (4.2) | 37.5 (8.1) | 50.7 (13.2) |
| Work experience, mean (SD) years | 4.4 (3.1) | 14.8 (7.9) | — |
| Communication tools used, % a | |||
| Telephone | 91 | 74 | 74 |
| Mobile phone calls | 92 | 66 | 83 |
| LINE messaging | 62 | 89 | 19 |
| Video calls | 62 | 68 | 12 |
| Communication preference, n (%) | |||
| Face‐to‐face only | 22 (22) | 27 (27) | 14 (14) |
| Digital only | 6 (6) | 24 (24) | 4 (4) |
| Both methods | 72 (72) | 49 (49) | 82 (82) |
| Overall satisfaction score (0–100), mean (SD), CI | |||
|
80.6 (10.9) (78.5–82.7) |
77.8 (13.5) (75.2–80.5) |
84.6 (11.4) (82.4–86.8) |
|
Abbreviation: SD, Standard deviation.
Participants could select multiple options; percentages may exceed 100%.
3.2. HF‐BDCS Scores and Group Comparisons
All three groups rated positive attitude (Item 11) as the factor most crucial to satisfaction within the perception dimension. This indicates that a friendly, respectful and caring attitude in healthcare providers is a critical element of digital communication success. In the communication efficiency and quality dimension, role‐specific challenges were evident: physicians gave the lowest score to faster medical decision‐making (Item 5), whereas nurses and family members rated reducing communication pressure (Item 3) lowest. These findings suggest role‐specific challenges: physicians find digital tools less effective for urgent decision‐making, whereas nurses and family members perceive digital communication as less helpful in reducing their communication workload or pressure (Table 2).
TABLE 2.
HF‐BDCS scores among physicians, nurses and family members.
| Item | Physicians M (SD) | Nurses M (SD) | Family M (SD) | F | p | Post hoc (Scheffé) |
|---|---|---|---|---|---|---|
| Digital communication efficiency and quality | ||||||
| 1. Digital communication methods eliminate the need for in‐person hospital visits, making communication more convenient for both parties. | 3.16 (0.75) | 3.21 (0.79) | 3.68 (0.56) | 16.50 | < 0.001 | F > P *, F > N * |
| 2. Digital communication methods allow both parties sufficient time for medical communication outside of fixed visiting hours. | 3.47 (1.11) | 3.36 (1.06) | 3.86 (0.80) | 6.97 | 0.001 | F > P *, F > N * |
| 3. Because digital communication methods do not require face‐to‐face interaction, they reduce stress for both parties. | 3.29 (0.98) | 3.07 (0.98) | 3.66 (0.79) | 10.50 | < 0.001 | F > P *, F > N * |
| 4. Digital communication methods facilitate communication between multiple family members and the healthcare providers. | 3.12 (1.00) | 3.03 (1.05) | 3.51 (0.85) | 6.94 | 0.001 | F > P *, F > N * |
| 5. When changes in a patient's condition require unexpected medical decisions, digital communication methods facilitate faster medical decision‐making. | 2.71 (1.09) | 3.54 (1.00) | 3.80 (0.59) | 3.60 | 0.029 | F > P * |
| 6. Digital communication methods can be as effective as face‐to‐face communication. | 2.91 (0.98) | 3.15 (0.98) | 3.61 (0.75) | 15.36 | < 0.001 | F > P *, F > N * |
| Subtotal: Efficiency and Quality (Items 1–6) | 3.11 (0.78) | 3.23 (0.81) | 3.69 (0.57) | 16.50 | < 0.001 | F > P *, F > N * |
| Digital communication perception | ||||||
| 7. Through digital communication methods, both parties can adequately understand and provide information regarding the patient's medical treatment during hospitalization. | 3.92 (0.76) | 3.69 (0.81) | 3.82 (0.70) | 2.30 | 0.102 | |
| 8. Digital communication methods enable both parties to express and understand the content of a message. | 3.52 (0.78) | 3.49 (0.92) | 3.86 (0.71) | 6.40 | 0.002 | F>P *, F>N * |
| 9. Through digital communication methods, both parties can listen patiently to each other. | 3.50 (0.82) | 3.31 (0.97) | 3.80 (0.73) | 8.50 | < 0.001 | F>P *, F>N * |
| 10. Through digital communication methods, both parties can actively express care or feel cared for. | 3.33 (0.94) | 3.58 (0.84) | 3.75 (0.69) | 6.29 | 0.002 | F>P * |
| 11. Through digital communication methods, both parties can communicate with a positive attitude. | 4.04 (0.58) | 3.95 (0.69) | 3.95 (0.66) | 0.62 | 0.542 | |
| Subtotal: Perception (Items 7–11) | 3.66 (0.63) | 3.60 (0.72) | 3.84 (0.62) | 3.84 | 0.023 | F>N * |
| Digital communication regulations | ||||||
| 12. The hospital provides clear information on regulations regarding digital communication between healthcare providers and families. | 3.35 (0.96) | 3.70 (1.00) | 3.67 (0.71) | 4.66 | 0.010 | N>P*, F>P * |
| 13. I know how to use the hospital's digital communication tools (e.g., LINE app, phone calls, online video calls or other communication software). | 3.71 (0.71) | 3.92 (0.80) | 3.74 (0.77) | 2.14 | 0.12 | |
| Subtotal: Regulations (Items 12–13) | 3.53 (0.80) | 3.81 (0.84) | 3.71 (0.65) | 3.39 | 0.035 | N>P* |
| Total Score (Items 1–13) | 3.41 (0.57) | 3.45 (0.64) | 3.75 (0.49) | 10.06 | < 0.001 | F>P *, F>N * |
Abbreviations: M, mean; SD, standard deviation.
p < 0.05.
One‐way ANOVA with Scheffé post hoc tests revealed significant intergroup differences. Family members scored significantly higher than healthcare providers on overall satisfaction (F = 10.06, p < 0.001) and efficiency and quality (F = 16.50, p < 0.001) and higher than nurses on communication perception (F = 3.84, p = 0.023). Nurses scored significantly higher than physicians on communication regulations (F = 3.39, p = 0.035). These findings highlight the distinct perspectives of different stakeholders about the effectiveness of digital communication (Table 2).
3.3. Correlation and Regression Analysis
Pearson correlation analysis revealed that the total HF‐BDCS score was strongly correlated with satisfaction (r = 0.60, p < 0.01). The perception score was most strongly correlated with satisfaction (r = 0.59), followed by the efficiency and quality (r = 0.57) and regulations (r = 0.36) scores. Age was weakly but significantly positively correlated with satisfaction (r = 0.13, p < 0.05). Additionally, significant positive correlations were noted among the three dimensions: efficiency and quality with perception (r = 0.66), efficiency and quality with regulations (r = 0.36) and perception with regulations (r = 0.39; Table 3).
TABLE 3.
Correlation analysis of digital communication satisfaction among physicians, nurses and family members.
| Satisfaction | Age | HF‐BDCS total score | Efficiency and quality | Perception | Regulations | |
|---|---|---|---|---|---|---|
| Satisfaction | 1 | |||||
| Age | 0.13* | 1 | ||||
| HF‐BDCS Total Score | 0.60** | 0.19** | 1 | |||
| Efficiency and Quality | 0.57** | 0.27** | 0.86** | 1 | ||
| Perception | 0.59** | 0.08 | 0.82** | 0.66** | 1 | |
| Regulations | 0.36** | 0.12* | 0.65** | 0.36** | 0.39** | 1 |
p < 0.05.
p < 0.01, Pearson correlation coefficients presented.
Stepwise regression identified three predictors of satisfaction: communication perception score (β = 0.34, p < 0.001), efficiency and quality score (β = 0.30, p < 0.001) and regulations score (β = 0.13, p = 0.010). The final model explained 40.9% of the variance in satisfaction (F = 70.10, p < 0.001; Table 4).
TABLE 4.
Stepwise multiple regression analysis of factors predicting digital communication satisfaction.
| Predictor variables | β | ΔR 2 | Cumulative R 2 | p |
|---|---|---|---|---|
| Communication perception | 0.34 | 0.340 | 0.340 | < 0.001 |
| Communication efficiency and quality | 0.30 | 0.058 | 0.398 | < 0.001 |
| Communication regulations | 0.13 | 0.011 | 0.409 | 0.010 |
Note: β, standardized regression coefficient; ΔR 2 = R‐square change. Dependent variable = digital communication satisfaction. Stepwise multiple regression analysis; overall model: F = 70.097, p < 0.001.
3.4. Stakeholder Recommendations
Among 300 participants, 176 (58.7%) provided open‐ended suggestions (70 physicians, 79 nurses and 27 family members), yielding 13 recommendations across five themes: regulations, purposes, personnel, equipment and communication quality (Table 5). Equipment concerns (hardware and software) were the most frequently mentioned barriers, with 166 mentions across all stakeholder groups (Table 5), representing 67% of all recommendations. This overwhelming emphasis on technical infrastructure indicates that hardware and software issues are the primary barrier to effective digital communication in ICU settings.
TABLE 5.
Recommendations from physician, nurse and family member participants regarding digital communication in ICUs.
| Themes and recommendations | Physicians (n = 70) | Nurses (n = 79) | Families (n = 27) | Total mentions |
|---|---|---|---|---|
| Regulations | 4 | 15 | 4 | 23 |
| 1. Establish fixed communication times | 4 | 5 | 4 | 13 |
| 2. Address privacy/security and infection control concerns a | 0 | 10 | 0 | 10 |
| Purposes | 9 | 3 | 1 | 13 |
| 3. Incorporate online consent‐form signing function | 6 | 2 | 0 | 8 |
| 4. Add other digital functions (e.g., recording, call logs, health education) | 3 | 1 | 1 | 5 |
| Personnel | 10 | 22 | 6 | 38 |
| 5. Assign staff dedicated to communication with families | 10 | 17 | 5 | 32 |
| 6. Address difficulty of older adults using digital devices | 0 | 5 | 1 | 6 |
| Equipment (hardware and software) | 79 | 73 | 14 | 166 |
| 7. Improve hardware/software (insufficient, outdated, difficult to use) | 42 | 62 | 3 | 107 |
| 8. Add multiple digital communication tools | 22 | 6 | 11 | 39 |
| 9. Establish official unit accounts | 10 | 4 | 0 | 14 |
| 10. Provide space for multiuser video communication | 5 | 3 | 0 | 6 |
| Communication quality | 0 | 2 | 6 | 8 |
| 11. Address difficulty understanding medical terminology a | 0 | 0 | 3 | 3 |
| 12. Ensure sufficient time for communication and decision‐making | 0 | 1 | 3 | 4 |
| 13. Promote communication across medical teams a | 0 | 1 | 0 | 1 |
| Total mentions | 102 | 115 | 31 | 248 |
Note: n represents the number of participants from each group who provided open‐ended suggestions (response rates: physicians 70%, nurses 79%, family members 27%). Equipment concerns were the most frequently mentioned theme across all groups, with Item 7 (improve hardware/software) being the most frequently mentioned specific recommendation.
Recommendations mentioned by only one participant group, reflecting role‐specific concerns.
Role‐specific concerns emerged. The physicians emphasized hardware limitations and the need for multiple communication methods. The nurses highlighted equipment issues and the need for dedicated communication staff to reduce workload. The family members focused on diverse communication methods and dedicated support.
Only nurses raised privacy, infection control and inter‐team communication concerns, reflecting their safety and coordination responsibilities. Participants across all groups also recommended establishing fixed communication times to improve coordination. Only family members identified difficulties understanding medical terminology, highlighting the need for enhanced health education support.
4. Discussion
This study examined digital communication satisfaction among physicians, nurses, and families in ICUs. Family members reported significantly higher satisfaction (84.6) than physicians (80.6) and nurses (77.8). Communication perception emerged as the strongest predictor (β = 0.34, p < 0.001), underscoring the importance of empathetic communication in digital contexts. Healthcare providers and families showed distinct priorities: nurses emphasized communication regulations and privacy, physicians focussed on decision‐making efficiency and families valued information accessibility.
4.1. Multistakeholder Satisfaction With Digital Communication
Overall satisfaction demonstrated a strong positive correlation with the total HF‐BDCS score (r = 0.60, p < 0.01). Family members reported the highest overall satisfaction (84.6), reflecting distinct differences in role positioning and expectations across the three stakeholder groups.
The higher family member satisfaction aligns with the results of studies reporting the psychological benefits of digital communication during periods of visitation restrictions. Reviews and empirical studies have indicated that digital communication interventions enhance satisfaction and psychological well‐being, reducing anxiety and loneliness while improving comprehension and trust in care teams and maintaining family engagement [2, 15, 16, 17]. Research on end‐of‐life communication has shown that video calls are feasible and valued by families during isolation [3, 4], with families developing strong emotional attachments to remote communication systems. Being able to participate in a virtual farewell as part of end‐of‐life communication was regarded as an important source of comfort for families. However, studies also emphasize that digital communication cannot fully replace in‐person presence, particularly for emotionally sensitive situations [4]. In contexts involving restricted visiting, any form of contact is valued and leads to satisfaction [8]. Effective communication with families in complete isolation requires structured strategies and emotional support [3].
By contrast, nurses' lower satisfaction score (77.8) highlights the impact of digital communication on nursing workflows, including added communication burden, technical challenges and interprofessional coordination demands. This difference suggests that nurses must balance meeting family needs with maintaining the quality of patient care. Research has documented challenges in remote ICU family communication [8], with nurses experiencing particular difficulty maintaining emotional connection and managing coordination demands when supporting families from a distance [7].
All groups identified positive communication attitude as the factor most crucial to satisfactory digital communication, confirming that empathy and interpersonal warmth remain essential regardless of communication medium.
4.2. Predictors of Digital Communication Satisfaction
Multiple linear regression analysis identified three significant predictors of overall digital communication satisfaction (listed from most to least significant): communication perception, communication efficiency and quality and communication regulations. Communication perception had the largest β value, indicating it contributed the most to predicting satisfaction.
Communication perception being the strongest predictor highlights that family members emphasize healthcare providers' caring attitude, emotional responsiveness and empathy in digital communication. This finding is supported by studies confirming that structured emotional care and nonverbal expressions are indispensable in telemedicine communication because they facilitate positive feedback and establish a sense of security and trust in patients and family members [9, 18].
The significant predictive power of ‘communication efficiency and quality’ emphasizes the importance of clear, timely information delivery in digital contexts. Studies have consistently found that the clarity and consistency of clinical information provided by healthcare teams are key factors influencing patients' and families' overall care satisfaction. Digital communication systems offer time efficiency and convenient information integration, making them particularly valuable in cross‐institutional or cross‐time zone contexts [19, 20]. This concept aligns with the strong correlation this study discovered between satisfaction and the communication efficiency and quality subscale (r = 0.57, p < 0.01), highlighting that effective health education and information exchange are critical components of digital communication satisfaction.
This study also revealed the importance of communication regulations, which indicates that clear institutional protocols can enhance the quality and stability of digital communication. Researchers have recommended that healthcare institutions develop comprehensive operational guidelines—including appointment processes, privacy protocols, technical support and standard communication templates—to ensure consistency and patient safety [21]. Doing so would address the need for structured communication processes identified across stakeholder groups in this study.
Existing literature has identified three major domains of digital communication in ICUs: emotional support and receptivity, communication efficiency and information quality and structured communication regulations that facilitate participation [5, 8, 9, 10, 15, 22]. The findings of this study correspond to these domains through three predictors—digital communication perception, digital communication efficiency and quality and digital communication regulations—which together capture the emotional, informational and structural dimensions of digital communication in ICUs. This correspondence underscores the alignment between the study framework and established evidence, confirming that emotional support, information quality and structured processes are essential components of effective ICU digital communication.
4.3. Practice Improvement Strategies
Systematic analysis of stakeholder recommendations revealed several multidimensional challenges in ICU digital communication. Technical equipment problems were unanimously identified as a key challenge. Research conducted in various countries has confirmed that equipment accessibility and stability directly affect the feasibility and effectiveness of digital communication, with technical problems directly influencing users' emotional experiences and trust establishment [2, 8, 9].
Regarding human resources and process optimization, both nurses and families reported a need for dedicated personnel and timely information provision. Multiple studies have indicated that healthcare teams are often concerned that digital communication will increase their administrative burden and time pressure [2, 8, 10].
One promising approach to address workload concerns is the establishment of Digital Communication Liaison roles or family communication coordinator models. These designated staff members manage routine family updates, coordinate communication across care teams and shifts and respond to non‐urgent inquiries. This staffing model has been successfully implemented in ICU settings to reduce frontline clinician burden while enhancing communication quality and consistency [22].
In the current study, privacy security and team coordination emerged as important concerns, particularly among nurses who serve as primary coordinators of family communication. Studies have indicated that the needs of people in different roles with respect to data protection and process safety must be addressed during medical digitalization and that the effects of digitalization on internal team communication patterns must be considered [23]. The present study's finding of families struggling to understand medical terminology aligns with previous findings regarding unidirectional communication and professional terminology barriers [24]. The digital platforms used in medical settings are currently insufficient to promote genuine bidirectional understanding.
4.4. Limitation
This study has several limitations. First, the cross‐sectional design precluded causal inference and did not capture long‐term effects. Additionally, data collection spanned 9 months, during which changes in institutional practices or technology familiarity may have influenced satisfaction.
Second, selection bias may exist as participation was voluntary; those who declined may have had different satisfaction levels, potentially affecting representativeness.
Third, methodological constraints include reliance on quantitative measures that limited exploration of nuanced judgements and use of a single‐item satisfaction scale not specifically validated for this context. Additionally, the discrepancy in reported video call usage between healthcare providers (62%–68%) and family members (12%) may reflect the study's sampling design, where only one family representative per patient completed the study. This representative may not have been the family member who participated in video communications, even though other family members of the same patient may have done so. This sampling consideration should be noted when interpreting digital communication usage patterns across stakeholder groups.
Fourth, data were collected from a single medical centre in Taiwan, limiting generalizability. Findings should be interpreted considering differences in healthcare infrastructure, family visitation policies and cultural norms regarding family involvement in medical decision‐making.
4.5. Recommendation for Clinical Practice
Based on our findings, we propose evidence‐based recommendations to optimize digital communication in ICU settings. Given that communication perception was the strongest predictor of satisfaction (β = 0.34, p < 0.001), with all stakeholder groups identifying positive attitude as most crucial, healthcare institutions should prioritize training programs that enhance empathetic communication skills in digital contexts [25].
To address nurses' significantly lower satisfaction (77.8 vs. 84.6) and concerns regarding workload and coordination, institutions should consider implementing Digital Communication Liaison roles as recommended by participants (Table 5, Item 5) and discussed above. This model can reduce bedside nurse burden [26] while ensuring consistent family communication.
Equipment and software issues were the most frequently cited barriers (166 mentions, Table 5), requiring investment in reliable technical infrastructure including improved hardware, multiple communication tools and technical support. Clear institutional guidelines governing digital communication practices, privacy protection and workflow integration should be developed [27] to address nurses' emphasis on communication regulations and participants' recommendations for fixed communication times and security protocols.
Finally, healthcare providers should develop strategies to simplify medical explanations and provide educational support through digital channels [28] to address family members' difficulties understanding medical terminology. These targeted recommendations directly respond to the role‐specific priorities identified across physician, nurse, and family stakeholder groups.
5. Conclusion
Communication perception emerged as the strongest predictor of digital communication satisfaction, underscoring the importance of empathetic communication across all healthcare provider interactions. Family members reported significantly higher satisfaction than healthcare providers, reflecting digital communication's value while highlighting implementation barriers that particularly affect clinical staff. Privacy, team coordination and workload concerns emerged as key challenges, while families' difficulty in understanding medical terminology highlights the need for enhanced health literacy support. These findings provide evidence for developing safe, efficient, family‐centred digital communication strategies in ICUs.
Funding
This research was supported by the National Taiwan University Hospital General Research Project (Grant Number: 112‐M0030). The funding source had no involvement in study design, data collection, analysis, interpretation, writing of the report or the decision to submit the article for publication.
Ethics Statement
This study was approved by the Institutional Review Board of National Taiwan University Hospital (approval number: 202207043RINC; approval date: October 4, 2022) and conducted in accordance with the Declaration of Helsinki.
Consent
Confirmation that informed consent was obtained. All participants provided written informed consent. Confidentiality was maintained throughout, and participants could withdraw at any time without consequence.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
We sincerely thank all the physicians and nursing staff at National Taiwan University Hospital for their exceptional support and assistance with participant recruitment and data collection. We also acknowledge the hospital administration for facilitating this research.
Data Availability Statement
The datasets generated and analysed during the current study are not publicly available due to privacy and ethical restrictions but may be accessed upon reasonable request and with approval from the Research Ethics Committee C of National Taiwan University Hospital (Email: ntuhrec@ntu.edu.tw; IRB No.: 202207043RINC). The data are securely stored on the institutional research server and will be maintained for long‐term preservation according to institutional data retention policies.
References
- 1. Mailer J., Ward K., and Aspinall C., “The Impact of Visiting Restrictions in Intensive Care Units for Families During the COVID‐19 Pandemic: An Integrative Review,” Journal of Advanced Nursing 80 (2024): 1355–1369, 10.1111/jan.15915. [DOI] [PubMed] [Google Scholar]
- 2. Rose L., Yu L., Casey J., et al., “Communication and Virtual Visiting for Families of Patients in Intensive Care During the COVID‐19 Pandemic: A UK National Survey,” Annals of the American Thoracic Society 18, no. 10 (2021): 1685–1692, 10.1513/AnnalsATS.202012-1500OC. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Mistraletti G., Gristina G., Mascarin S., et al., “How to Communicate With Families Living in Complete Isolation,” BMJ Supportive & Palliative Care 14, no. e3 (2024): e2954–e2965, 10.1136/bmjspcare-2020-002633. [DOI] [PubMed] [Google Scholar]
- 4. Galazzi A., Binda F., Gambazza S., Lusignani M., Grasselli G., and Laquintana D., “Video Calls at End of Life Are Feasible but Not Enough: A 1‐Year Intensive Care Unit Experience During the Coronavirus Disease‐19 Pandemic,” Nursing in Critical Care 26, no. 6 (2021): 531–533, 10.1111/nicc.12647. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Kennedy N. R., Steinberg A., Arnold R. M., et al., “Perspectives on Telephone and Video Communication in the Intensive Care Unit During COVID‐19,” Annals of the American Thoracic Society 18, no. 5 (2021): 838–847, 10.1513/AnnalsATS.202006-729OC. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Xyrichis A., Pattison N., Ramsay P., et al., “Virtual Visiting in Intensive Care During the COVID‐19 Pandemic: A Qualitative Descriptive Study With ICU Clinicians and Non‐ICU Family Team Liaison Members,” BMJ Open 12, no. 4 (2022): e055679, 10.1136/bmjopen-2021-055679. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Conte H., Dorell Å., Wedin E., and Eckerblad J., “In Their Absence: Intensive Care Nurses' Experiences of Communicating and Supporting Relatives From a Distance,” BMC Nursing 22, no. 1 (2023): 421, 10.1186/s12912-023-01559-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Sasangohar F., Dhala A., Zheng F., Ahmadi N., Kash B., and Masud F., “Use of Telecritical Care for Family Visitation to ICU During the COVID‐19 Pandemic: An Interview Study and Sentiment Analysis,” BMJ Quality and Safety 30, no. 9 (2021): 715–721, 10.1136/bmjqs-2020-011604. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Musters S. C., Coolen C. M., Jongerden I. P., Schijven M. P., Maaskant J. M., and Eskes A. M., “Experiences of Healthcare Professionals, Patients and Families With Video Calls to Stimulate Patient‐ and Family‐Centred Care During Hospitalization: A Scoping Review,” Journal of Clinical Nursing 33, no. 9 (2024): 3429–3467, 10.1111/jocn.17155. [DOI] [PubMed] [Google Scholar]
- 10. Oudbier S. J., Souget‐Ruff S. P., Chen B. S. J., Ziesemer K. A., Meij H. J., and Smets E. M. A., “Implementation Barriers and Facilitators of Remote Monitoring, Remote Consultation and Digital Care Platforms Through the Eyes of Healthcare Professionals: A Review of Reviews,” BMJ Open 14, no. 6 (2024): e075833, 10.1136/bmjopen-2023-075833. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. von Elm E., Altman D. G., Egger M., et al., “The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies,” Lancet 370, no. 9596 (2007): 1453–1457, 10.1016/S0140-6736(07)61602-X. [DOI] [PubMed] [Google Scholar]
- 12. Cohen J., Statistical Power Analysis for the Behavioral Sciences, 2nd ed. (Lawrence Erlbaum Associates, 1988). [Google Scholar]
- 13. Green S. B., “How Many Subjects Does It Take to Do a Regression Analysis,” Multivariate Behavioral Research 26, no. 3 (1991): 499–510, 10.1207/s15327906mbr2603_7. [DOI] [PubMed] [Google Scholar]
- 14. Diao Y. C. and Lou M. F., “Development and Validation of the Healthcare Provider and Family Bidirectional Digital Communication Scale,” PLoS One 20, no. 12 (2025): e0338410, 10.1371/journal.pone.0338410. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Shin J. W., Choi J., and Tate J., “Interventions Using Digital Technology to Promote Family Engagement in the Adult Intensive Care Unit: An Integrative Review,” Heart & Lung 58 (2023): 166–178, 10.1016/j.hrtlng.2022.12.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Kebapcı A. and Türkmen E., “The Effect of Structured Virtual Patient Visits on COVID‐19 Patients and Relatives' Anxiety Levels in Intensive Care Unit,” Journal of Clinical Nursing 31, no. 19–20 (2022): 2900–2909, 10.1111/jocn.16117. [DOI] [PubMed] [Google Scholar]
- 17. Hao X., Qin Y., Lv M., Zhao X., Wu S., and Li K., “Effectiveness of Telehealth Interventions on Psychological Outcomes and Quality of Life in Community Adults During the COVID‐19 Pandemic: A Systematic Review and Meta‐Analysis,” International Journal of Mental Health Nursing 32, no. 4 (2023): 979–1007, 10.1111/inm.13126. [DOI] [PubMed] [Google Scholar]
- 18. Varghese M. P., Selwyn T., Nair S., Samuel S., Chacko B., and Pichamuthu K., “Assessment of Family Satisfaction With Remote Communication for Critically Ill COVID‐19 Patients: An Observational Cohort Study,” Indian Journal of Critical Care Medicine: Peer‐Reviewed, Official Publication of Indian Society of Critical Care Medicine 27, no. 8 (2023): 537–544, 10.5005/jp-journals-10071-24504. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Camões J., Tintim Lobato C., Carvalho D., Gomes E., and Araújo R., “Family Satisfaction in Intensive Care During the COVID‐19 Pandemic Using the FS‐ICU24 Questionnaire,” Acta Médica Portuguesa 35, no. 12 (2022): 859–865, 10.20344/amp.17128. [DOI] [PubMed] [Google Scholar]
- 20. Gherman A., Andrei D., Popoiu C. M., et al., “Multidisciplinary Telemedicine in Healthcare During and After the COVID‐19 Pandemic: A Narrative Review,” Life (Basel) 15, no. 5 (2025): 783, 10.3390/life15050783. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. Hart J. L., Turnbull A. E., Oppenheim I. M., and Courtright K. R., “Family‐Centered Care During the COVID‐19 Era,” Journal of Pain and Symptom Management 60, no. 2 (2020): e93–e97, 10.1016/j.jpainsymman.2020.04.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Lopez‐Soto C., Bates E., Anderson C., et al., “The Role of a Liaison Team in ICU Family Communication During the COVID‐19 Pandemic,” Journal of Pain and Symptom Management 62, no. 3 (2021): e112–e119, 10.1016/j.jpainsymman.2021.04.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Xyrichis A., Iliopoulou K., Mackintosh N. J., et al., “Healthcare Stakeholders' Perceptions and Experiences of Factors Affecting the Implementation of Critical Care Telemedicine: Qualitative Evidence Synthesis,” Cochrane Database of Systematic Reviews 2, no. 2 (2021): CD012876, 10.1002/14651858.CD012876.pub2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Forsberg T., Isaksson M., Schelin C., Lyngå P., and Schandl A., “Family Members' Experiences of COVID‐19 Visiting Restrictions in the Intensive Care Unit: A Qualitative Study,” Journal of Clinical Nursing 33, no. 1 (2024): 215–223, 10.1111/jocn.16637. [DOI] [PubMed] [Google Scholar]
- 25. Byrne M., Campos C., Daly S., Lok B., and Miles A., “The Current State of Empathy, Compassion and Person‐Centred Communication Training in Healthcare: An Umbrella Review,” Patient Education and Counseling 119 (2024): 108063, 10.1016/j.pec.2023.108063. [DOI] [PubMed] [Google Scholar]
- 26. Yoon Y., Roberts T., Keogh B., and Yazdany J., “Using Real‐Time Data to Mitigate Nurse Burnout and Turnover,” Nurse Leader 21, no. 5 (2023): 457–460, 10.1016/j.mnl.2023.07.012. [DOI] [Google Scholar]
- 27. Jawad L. A., “Security and Privacy in Digital Healthcare Systems: Challenges and Mitigation Strategies,” Journal of Health Management 26, no. 1 (2024): 85–98, 10.1177/09702385241233073. [DOI] [Google Scholar]
- 28. Fitzpatrick P. J., “Improving Health Literacy Using the Power of Digital Communications to Achieve Better Health Outcomes for Patients and Practitioners,” Frontiers in Digital Health 5 (2023): 1264780, 10.3389/fdgth.2023.1264780. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and analysed during the current study are not publicly available due to privacy and ethical restrictions but may be accessed upon reasonable request and with approval from the Research Ethics Committee C of National Taiwan University Hospital (Email: ntuhrec@ntu.edu.tw; IRB No.: 202207043RINC). The data are securely stored on the institutional research server and will be maintained for long‐term preservation according to institutional data retention policies.