A tool to strengthen the older patient-companion partnership in primary care: results from a pilot study

Abstract

Objectives: To determine the acceptability of a pre-consultation checklist for older adults who attend medical visits with an unpaid companion and to evaluate its effects on visit communication.

Design: Randomized controlled pilot study.

Setting: Academic geriatrics ambulatory clinic.

Participants: Thirty-two individuals aged 65 and older and their unpaid companions.

Intervention: A self-administered checklist was compared with usual care. The checklist was designed to elicit and align patient and companion perspectives regarding health concerns to discuss with the doctor and stimulate discussion about the companion's role in the visit.

Primary outcome: ratio of patient-centered communication, coded from visit audiotapes.

Secondary outcomes: checklist acceptability; visit duration; patient-companion verbal activity; patient- and physician-reported perspectives of the visit.

Results: All intervention patients and companions (n = 17) completed the checklist, and all participants (n = 32 dyads) completed the study. Patients and companions stated that the checklist was easy to complete (88%) and useful (91%), and they uniformly (100%) recommended it to other patients. Communication was significantly more patient-centered in intervention group visits (ratio of 1.22 vs 0.71; P = .03). Visit duration (35.0 and 30.6 minutes; P = .34) and percentage of total verbal activity contributed by patients and companions (58.2% and 56.3% of visit statements; P = .50) were comparable in the intervention and control groups, respectively. Physicians were more likely to indicate that intervention companions "helped them provide good care to the patient" (94% vs 60%; P = .02). Intervention patients were more likely to indicate that they "better understood their doctor's advice and explanations" because their companion was present (82% vs 47%; P = .03).

Conclusion: A checklist to elicit and align perspectives of older adults and their companions resulted in enhanced patient-centered medical visit communication.

Keywords: family caregiver; patient-provider communication; physician office; primary health care.

Conflict of interest statement

Conflict of Interest:

FUNDING: This study was supported by National Institute of Mental Health grant K01MH082885 “Optimizing Family Involvement in Late-Life Depression Care” to Jennifer Wolff.

Jennifer Wolff: (In respect to Grants) reports funding from National Institute of Mental Health grant K01MH082885

Debra Roter: (In respect to Royalties). I am the author of the Roter Interaction Analysis System (RIAS) and hold the copyright for the system. Johns Hopkins University also has rights to the RIAS coding software. Neither Debra Roter nor Johns Hopkins collects royalties for use of the system in research as is the case for the current study.

(In respect to Affiliation) I am a co-owner of RIASWorks LLC, a company that provides RIAS coding services for non-university projects and it is possible that RIASWorks would benefit indirectly from dissemination of the current research.

Jeremy Barron: no conflicts

Cynthia Boyd: (In respect to Grants) reports receipt of a Paul Beeson Career Development Award (NIA K23 AG032910 from AFAR, The John A. Hartford Foundation, The Atlantic Philanthropies, The Starr Foundation and an anonymous donor).

Bruce Leff: (In respect to Affiliation) reports member of Measure Application Partnership, National Quality Forum Post-Acute and Long-Term Care Committee, (In respect to Grants) reports funding from NIA, John A. Hartford Foundation, Commonwealth Fund, and Retirement Research Fund, (In respect to Honoraria) reports CMS Technical Expert Panels, (In respect to Consultant) reports L&M Policy Research Group, (In respect to Royalties) reports Hospital at Home, (in respect to Board Member) reports American Academy of Home Care Physicians, American College of Physicians, Alliance for Home Health Quality and Innovation.

Thomas Finucane: no conflicts

Peter Rabins: (In respect to Royalties). I receive book royalties for “The 36-Hour Day.”

Joseph Gallo: no conflicts

David Roth: no conflicts

Laura Gitlin: no conflicts

© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Figures

Figure 1

Study Participant Recruitment and Randomization.