Table 3.

Benefits and Barriers to Standardized Caregiver Assessment

Potential benefits of standardized caregiver assessment ABetter patient care “The caregiver’s health is important. Particularly as the person gets more sick it’s so important that [the caregiver] get their health taken care of, not just their physical health but their mental health.” (internist) “The most important thing that they [clinicians] need to know is that I have a very large responsibility where he [patient] is concerned and [his] healthcare. Ultimately that will affect his [patient’s] care because if anything happens to me, then he is no longer able to stay at home.” (spouse caregiver) “The doctors should make an attempt to find out how the [caregiving] situation involves the patient’s health. the physician involved should be aware of their [the patient’s] surroundings.” (patient) BImproved caregiver-provider communication “They [caregivers] can answer whatever they want in a survey. and based on that feedback you can rearrange your approach so that you can be more effective.” (nurse) “There are two varieties [of caregivers]. There are the ones [caregivers] that do not complain. and there’s others that complain bitterly because of the resentment of the situation and watching their person disintegrate. So, I think, getting people to talk in a productive way.” (spouse caregiver) “It’s important for the doctor to be able to assess the input of the caregiver. to understand whom she’s speaking with and what the caregiver is capable of communicating to the doctor.” (patient) CValidation of caregivers’ efforts “If they feel like they [caregivers] are being validated and somebody is acknowledging the burden they are facing. Some of them will feel better because they have gotten things off their chest.” (geriatrician) “I wish when my mom was caring for my dad that their shared doctor had asked how she was doing. It would have been comforting for her to hear that people appreciate. or ask if she needed help.” (patient)

Challenges and barriers to standardized caregiver assessment DInsufficient time “It’s a time constraint. It’s another thing to do that’s not part of the visit that you still have to document all the other stuff. So, if the patient does not have much going on and you have a lot of time to talk about [caregiver issues], if the patient has a lot of new symptoms you really do not have time.” (geriatrician) EInadequate reimbursement “[When] the family member comes into talk it’s hard to bill it as a visit because there is no physical exam, there is no patient. There may be billing codes for goals of care, maybe you could do that.” (geriatrician) “I cannot devote as much time to the caregiver as I can to the patient. I just spent 20 minutes on the phone with a family caregiver and I had like a 30-minute visit with them yesterday and I cannot, I am not billing for a 15-minute visit.” (geriatrician) FApprehensions about personal liability and inability to act on identified concerns “The one thing that I could not do if the person were not my patient is to refer to our social worker. I do try if they feel you know really stressed and everything to try to give them resources or idea.” (nurse) “Doctors tend to be insecure about stirring up feelings that are below the surface.A tendency with doctors to want to not rock the boat and deal with the fear of not being equipped to do counseling.” (patient) GLack of awareness of community resources “I do not feel like I’m an expert at any of them [community resources] because each organization might have its own thing that they can do or not do.” (geriatrician) HConcerns about patient autonomy “It all depends on the capacity of the individual and what permission I have. So, I will not have those conversations unless I have direction from the patient and often indirection from them.” (internist) “I do not want to get into a whole story about me. It’s not really about me. It’s about just taking care of my mother and what’s the best situation for her.” (spouse caregiver) “I invite [caregiver] in, but she does not like to. She feels I should have privacy with the doctor.” (patient)