THURS-101 - Patient-provider Communication Gaps in Care After Miscarriage, Stillbirth, and Infant Loss

Brief Abstract Summary: Common challenges during or following pregnancy experienced by women are miscarriage, stillbirth, and infant mortality and insufficient patient-provider communication adds to patient distress, while patient-centered provider communication improves patient satisfaction and engagement, supports their individual needs, and empowers their adherence. In this study, we encoded interview transcripts surrounding miscarriage, stillbirth, and infant mortality experienced by African American females using a two-stage thematic analysis, including open and axial coding. Four themes emerged, including fragmented continuity of care, negative interactions, patient-centered communication, and trust-building qualities. A lack of sustained support, continuity, and empathy from providers left participants feeling isolated in their care and undermined the patient-provider relationship, while patient-centered care integration with reassurance and clear, proactive communication fostered trust and connection.

Detailed abstract description: Common pregnancy complications experienced by women are miscarriage, stillbirth, and infant mortality; yet many patients do not understand the cause or complexity.¹ Studies show that insufficient communication from providers, often lacking training in delivering bad news or using patient-centered approaches, adds to the distress surrounding miscarriage, stillbirth, and infant mortality. Patient-centered communication improves satisfaction, supports individual needs, and empowers adherence.² Thus, it is vital to use this approach, particularly in difficult conversations. This study explored how communication with healthcare providers during miscarriage, stillbirth, and infant mortality affected patients’ experiences within the healthcare system.
Principal investigators analyzed one-hour audio-recorded interviews from the Pregnancy and Infant Loss (PAIL) study, which examined experiences of African American families who had experienced miscarriage, stillbirth, or infant mortality. Participants included 150 adults (100 women, 50 men) from Cuyahoga County. For this analysis, investigators focused on 100 female transcripts under the subdomain “patient-provider communication: treatment.” A two-stage thematic analysis using Dedoose was conducted. In the first stage, transcripts underwent open coding to identify child and parent codes; in the second stage, axial coding organized these into recurrent themes by investigator consensus.
Four major themes emerged: fragmented continuity of care, negative interactions, patient-centered communication, and trust-building qualities. Participants frequently reported being lost to follow-up, lacking resource access, encountering inconsistent providers, and reflecting fragmented continuity of care. One participant noted, “I felt, of course, she was concerned but busy; I felt kind of alone.” Negative interactions centered on the absence of emotional support, dissatisfaction, and systemic bias. A participant explained, “He was more concerned with it from a medical perspective than a human perspective,” illustrating emotional distance in care. In contrast, patient-centered communication involved proactive engagement, provision of resources, and curiosity for clarity. Trust-building qualities included empathy, reassurance, and supportive relationships. As one patient described, “She [the physician] was great. She made me feel like it wasn’t my fault, but consoled me in a way where I had hope after my loss.”
Overall, participants’ experiences underscored that inconsistent care and limited empathy can erode trust and satisfaction, while proactive, empathetic communication fosters connection and healing. Previous studies show that continuity of care improves outcomes, satisfaction, and cost-effectiveness.³ Future research should evaluate interventions that enhance empathy, continuity, and patient-centered communication within clinical care for miscarriage, stillbirth, and infant mortality.