Working with patients' families and caregivers
Key Takeaways
The majority of clinicians recognize the importance of communicating with patients’ families and caregivers, but often lack the time to do so.
Physicians can support family caregivers by cultivating “authentic healing” relationships throughout the duration of care.
Welcoming the participation of caregivers and family members ultimately paves the way to better patient care.
Improving patient communication is an ongoing pursuit for medical residents. Regardless of what stage residents are in their training, the AMA suggests they give some attention to developing effective communications skills. One helpful mnemonic device for remembering a comprehensive list of communicative strategies is the word RESPECT, which stands for rapport, explain, show, practice, empathy, collaboration, and technology.[]
When it comes to communicating with patients’ family members and caregivers, however, the protocol requires a few adjustments. To provide the best possible care, doctors can welcome, support, and engage caregivers in their participation in the patient’s care, as well as facilitate ongoing communication and expectation setting during hospitalizations.
Common communication roadblocks
Residents should take note of the unique challenges that healthcare practitioners (HCPs) face when communicating with the families and caregivers of patients.
According to a 2019 AARP article reporting on a survey of 400 physicians, NPs, and PAs, 97% of HCPs agree that caregivers make an important contribution to patient care. Of the participating physicians, 65% said that they expect to collaborate more often with caregivers in the future.[]
But they also expressed a few roadblocks that prevent the relationship from flourishing. Among them, 54% of HCPs reported that there were barriers for establishing a relationship in a situation where a patient has several caregivers.
An additional 44% of HCPs noted a lack of awareness of who the primary caregiver was, and the same percentage identified fluctuations in the caregiver’s level of involvement.
In addition, 39% of providers reported feeling that engagement with caregivers ate up too much time. Of the providers who felt that initiating or maintaining communication with caregivers was difficult, 20% reported the primary reason was that they were unable to reach the caregiver.
Forge meaningful partnerships
Ideally, residents can address the challenges found in facilitating meaningful partnerships with patients’ families and caregivers by gaining exposure to them during training. For those looking for additional real-world guidance, the current advice designed for practicing doctors encompasses several areas.
In an article published by the Annals of Internal Medicine, the American College of Physicians outlines four principles for caregiver/family involvement on behalf of patients.[] The first two pertain to physicians.
The first principle is to treat patients and families with dignity and respect. Doctors can do this by maintaining thoughtful communication with all parties and actively listening to them without interruption.
Holding the meeting in private is respectful. Patients and their families should discuss specifics, such as how they’d like to be addressed, and if they require help filling out forms or need additional educational information.
The second principle is to include the active participation of patients and families in all aspects of patient care. This goal can be met through informed, shared decision making to determine the best possible care plan, especially when several treatment options are available or the outcomes are uncertain.
Another tip is to engage, support, and empower caregivers. In an article published by the Collaborative Family Healthcare Association, Barry J. Jacobs, MD, emphasizes the importance of speaking with the family of chronically ill patients at the first medical appointment. This paves the way for mutual expectations about collaboration, and it gives the doctor the opportunity to gauge the caregiver’s abilities and see how much additional support the patient may need.[]
Supporting caregivers requires doctors to compile a list of resources for the family, as well as to make themselves available to caregivers. Cultivating an “authentic healing relationship” does a great service for long-term care plans.
Physicians can empower caregivers by detailing exactly what their roles entail. Some caretakers, for example, can take on the responsibility of recording the patient’s symptoms and the effects of treatment. You can emphasize how helpful this can be to the healthcare team.
Open communication with caregivers and family becomes especially important during hospitalizations. When a patient is hospitalized, establishing a connection with their point of contact is crucial, according to an article authored by Suneel Dhand, MD, and published on WoltersKluwer.com.[]
Dhand encourages doctors to communicate the patient’s diagnosis and prognosis to a family member at the first encounter and establish whether that person, or perhaps another, who might have better availability, will be the best contact.
Explain that you will need to be providing regular updates, preferably to one person who can then inform the rest of the family. Physicians can also expect patients’ families to ask questions that the patient may not ask, because they are viewing the situation from their point of view. Continue to update the family as needed, and keep them in the loop.
What this means for you
Medical residents can improve their communication with patients by practicing the tenets of RESPECT (rapport, explain, show, practice, empathy, collaboration, technology). When communication extends to patients’ families and caregivers, however, challenges may arise due to time constraints and lack of contact information.
Welcoming the participation of caregivers and family members ultimately paves the way for better patient care, and requires physicians to prioritize building authentic relationships with the patient’s points of contact. Together, the physician and caregivers can establish expectations for the duration of the patient’s care while maintaining open communication.