Table 3.
Approaches to Optimizing Interactions with Patient-Caregiver Dyads
| Approach | Clinician Perspectives | Patient and Caregiver Attitudes and Responses |
|---|---|---|
| Collaborating | A1. “I will try and… make it as much of a three-way conversation as possible. I will explicitly say ‘Since we have the benefit of having so-and-so here I’m going to ask” because the family often has a different perspective.” (geriatrician) | A3. “[The doctor helped facilitate] open discussion and [was] responsive to my personal need and respectful… We talked about [my speech impairment] in real depth… the doctor and my wife put in their points of view and it was really collegial.” (patient) |
| A2. “[Some]thing that can help is just trying to calm the situation down and explaining [that] I’m trying to get as much information as I can from both people… It’s not a judgement, it’s just information.” (geriatrician) | A4. “She’s a very responsive doctor. We feel very comfortable with her… Whatever I think is important she is willing to hear, and she checks with my mother as well.” (adult child) | |
| Dividing | B1. “My practice style is one in that I always talk to [and] examine, individuals, adults by themselves… I will invite [caregivers] back after the visit to express any concerns and you know, I’ll explain anything to [caregiver] that [they] want to know. It’s the right of the patient saying that it’s okay.” (internist) | B4. “I find it problematic and just kind of weird… [Doctor] doesn’t ever want anybody who is with the patient to go back into the exam room with them… I think that’s a situation that shouldn’t happen if the patient is comfortable with somebody else being with them.” (adult child) |
| B2. “I’ve discouraged caregivers from coming in… when the patient themselves can give me the story, they have full cognition, they speak English, there’s nothing that is impeding our communication.” (nurse) | B5. “I just like for my mom to have more you know, independent appointment. Most of the time I just sit in the waiting room and let her talk to the doctors. Now that has changed a little bit since she had her stent put in and the aortic valve replacement because I want to make sure I go in and talk to them.” (adult child) | |
| B3. “If it’s someone with cognitive impairment they’re not going to be terribly accurate about a lot of things, like what happened at the doctor’s visit or what the meds are. Depending on how impaired they are, my time alone with them will be fairly short” (nurse). | B6. “I couldn’t… ask honestly if [the doctors] thought [the treatment] was going to really work, because [patient] was there… I’d have to run back or if [patient] was going to the bathroom I’d ask that question by myself, because I wouldn’t want my husband to hear that.” (spouse caregiver) | |
| Focusing | C1. “Sometimes you have family members that pick up the ownership of the care, of especially people who are more frail or who are demented… so you talk with them. Sometimes it’s on the opposite spectrum where the caregiver comes in but the patient is still very functional and cognitively intact… I try to focus on the patient… I think you tailor, or at least I tailor kind of the interaction.” (geriatrician) | C4. Patient-focused: “I want the focus to be on [patient’s] medicine and what she has to do. I feel like the doctor’s job is to give her the information that she needs, and my job is to make sure that she follows through with it.” (adult child) |
| C2. Patient-focused: “[Sometimes] the patient gets pushed out of the way… [I] try to get the caregiver to stop talking for a minute and put the patient first and just say ‘I’d really like to just talk to Mr. So and So for a minute. Can you tell me more about what’s been going on?’ And then, have some sort of redirecting phrase.” (geriatrician) | C5. Family-focused: “[Patient] would cancel the appointment if they began talking to me as opposed talking to him… He would say, ‘Hey, I’m the patient here. You, doctor, are wasting my time. ‘” (spouse) | |
| C3. Family-focused: “If a patient is cognitively impaired and… they are not giving coherent responses, I’ll look to the caregiver much more than I would if the patient is able to be an accurate historian.” (internist) | C6. Family-focused: “I usually disagree and at that point [patient] usually disagrees with me and he will say something like… ‘I’m doing okay’… Typically, [the doctor] gives me a knowing look and we don’t talk about it any further than that” (spouse) |