Communication Challenges and Mitigation Strategies in Primary Care Virtual Consultations: Qualitative Study.

Background: The growing reliance on virtual consultations in primary care has reshaped traditional general practitioner (GP)-patient communication dynamics, presenting new challenges that affect care quality and safety. Objective: This study explores communication challenges and gaps, particularly relevant to virtual consultations compared with face-to-face interactions, as well as identifying mitigation strategies from both GPs' and patients' perspectives. Methods: This qualitative study employed 4 online focus group discussions with a purposive sample of UK-based GPs and patients. Data were analyzed using a deductive-inductive thematic approach with NVivo software. The extended Shannon-Weaver communication model and the Capability, Opportunity, Motivation and Behavior model guided the analysis of communication challenges and mitigation strategies, respectively. The Consolidated Criteria for Reporting Qualitative Research were followed to ensure rigorous reporting. Results: A total of 21 participants (12 patients and 9 GPs) took part in 4 online focus group discussions, 2 for patients and 2 for GPs. Six key themes on communication challenges emerged: 5 aligned with the extended Shannon-Weaver communication model (related to the sender-encoder, message, channel, receiver-decoder-feedback, and context), and a new one was inductively identified (patient autonomy and inclusivity). GPs, as senders, highlighted missing visual cues, affecting message clarity in remote communication channels. Patients, as receivers, reported difficulties explaining symptoms remotely, reduced emotional connection, and perceived empathy, linked to contextual challenges and the need for inclusive communication. Mitigation strategies were mapped to the Capability, Opportunity, Motivation and Behavior model: capability (training/resources), opportunity (triage/tools), and motivation (patient engagement/system adaptability), with participants emphasizing tailored training, standardized approaches, and flexible models to support effective and inclusive virtual communication. Conclusions: This study highlights communication gaps in virtual consultations and proposes actionable mitigation strategies. Tailored use of virtual modalities, supported by structured training and policy efforts, is essential to ensure effective and safe remote communication.