Chapter 2: Strategies to assess and engage with families

Broken trust

“When she was admitted to the ICU, we were told by the team that they did not understand why she was transferred as she was too sick. It was so demoralizing to have this breakdown in communication and be left feeling that the transfer to ICU was for nothing”. – Family member

How is trust broken?

  1. If a family comes into the ICU with their trust in health care already damaged, you might be left in the uncomfortable position of trying to rebuild broken trust.
  2. Poor communication and information gaps.


Information gaps that can diminish or destroy a family’s trust include:

  • Inconsistent information.
  • Excessive or confusing information (e.g., use of medical jargon).
  • Miscommunication or misinterpretation (e.g., the family may be expecting curative treatment, not end-of-life care).
  • Uncertainty regarding medical condition or prognosis.

Although uncertainty regarding medical condition or prognosis is inevitable at times, if it is not properly communicated it can lead to dissonance between the family’s interpretation or understanding of the situation and the clinical reality, which threatens the family’s trust in you and your team.   The best way to address uncertainty is to be transparent, which can also help build trust.

Clinician Tip

When trust is broken 

Clinician Tip