Involving family in treatment decision-making: A new conceptual framework and consultation strategies — ASN Events
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Involving family in treatment decision-making: A new conceptual framework and consultation strategies (#253)

Rebekah Laidsaar-Powell 1 , Phyllis Butow 1 , Stella Bu 1 , Cathy Charles 2 , Amiram Gafni 2 , Wendy Lam 3 , Kirsten McCaffery 4 , Jesse Jansen 4 , Heather Shepherd 5 , Martin Tattersall 5 , Ilona Juraskova 1
  1. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia
  2. Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
  3. School of Public Health, The University of Hong Kong, Hong Kong
  4. Screening and Diagnostic Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
  5. University of Sydney, Sydney, NSW, Australia

Aims

Family members are often considered to be vital members of the multidisciplinary care team. However, their involvement may raise challenges such as role confusion or reduced patient privacy. In three studies we explored patient, family and physician views on family involvement, their actual behaviours, and reviewed the evidence on this topic. We have utilised this research to propose a new conceptual framework and practical consultation strategies.

Methods

A systematic review identified 52 triadic consultation communication/decision-making papers. Interviews were conducted with 30 patients, 34 family members, 10 nurses and 11 oncologists examining attitudes and experiences. 20 audiotaped triadic oncology consultations were qualitatively analysed. On the basis of all of the above a new triadic interaction analysis (TRIO) coding system was developed and applied to 72 audiotaped cancer consultations.

Results

The systematic review revealed 5 themes, interviews with health professionals resulted in 10 themes, and interviews with patients/family were arranged into 11 themes. Although health professionals held positive attitudes to family involvement, they also reported many challenges such as conflicting patient-family treatment wishes. Physicians also highlighted strategies to manage family involvement. However, consultation analyses using the TRIO coding system revealed that physicians rarely initiated interaction with family members (e.g.10% invited family questions) and never clarified preferences for family members’ role. In 56% of consultations physicians interrupted the family member, and analyses revealed more experienced physicians were more likely to interrupt (p<.001). The varying roles of family in decision-making inside and outside of consultations were highlighted in patient/family interviews, and the issue of balancing patient decision-making authority with the ethical rights of the family was discussed.

Conclusion

Family can be helpful or challenging in cancer consultations. A triadic decision-making conceptual framework may help guide future research about ethical family involvement. Additionally, dissemination of practical strategies to improve consultation communication may be beneficial.

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