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 patients 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 patients age 65+ and their unpaid companion. Intervention A self-administered checklist was compared to usual care. The checklist was designed to: (1) elicit and align patient and companion perspectives regarding health concerns to discuss with the doctor, and (2) stimulate discussion about the companion’s role in the visit. Measurement 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 the checklist was easy to complete (88%), useful (91%), and they uniformly (100%) recommended it to other patients. Communication was significantly more patient-centered in intervention (versus control) group visits (ratio of 1.22 versus 0.71; p=0.03). Visit duration (35.0 and 30.6 minutes; p=0.34) and percent of total verbal activity contributed by patients and companions (58.2% and 56.3% of visit statements; p=0.50) were comparable in intervention and control groups, respectively. Physicians were more likely to indicate intervention (versus control) companions “helped them provide good care to the patient” (94% vs. 60%; p=0.02). Intervention (versus control) patients were more likely to indicate they “better understood their doctor’s advice and explanations” because their companion was present (82% vs. 47%; p=0.03). Conclusion A checklist to elicit and align perspectives of older patients and their companions resulted in enhanced patient-centered medical visit communication.

Examining the context and helpfulness of family companion contributions to older adults’ primary care visits

“…[10–12, 30] Moreover, as poor agreement between patients and families may be inversely associated with effective illness management, care planning, and quality of life [6, 10, 11, 31] strategies leading to a stronger patient-family partnership during medical communication could be of interest to a range of health system stakeholders. Although the pilot trial from which the data for this study originated improved the patient centeredness of medical visit communication, [21] we did not find evidence to suggest that the intervention exerted a significant effect on companions’ communication behaviors.…”

“…[6] Less effort has been directed at understanding and improving the capacity of family companions to productively engage in communication during face-to-face medical visits. [17, 29] We are unaware of studies other than our own [21] that have sought to strengthen family involvement by clarifying patients’ desired communication assistance. Strategies to elicit discussion between patients and families regarding patients’ treatment goals, priorities, and preferences merits consideration in light of evidence that patient-family agreement is generally low.…”

“…Detailed information regarding study recruitment and response rates have been previously reported. [21] Inclusion criteria for patients included being age 65 or older, English speaking, hearing well enough to communicate by telephone, seeing well enough to read large print, and being typically accompanied to doctor visits by an unpaid family member or friend. Older adults with significant cognitive deficits, defined as more than two incorrect answers on a 6-item cognitive screen[22], were excluded from study participation.…”

“…Following the work of Ishikawa, [20] we hypothesized that patients would report companions to be most helpful when companion contribution to visit communication was consistent with patients’ preferences. Finally, we examine whether a patient-companion pre-visit agenda-setting intervention that was previously found to improve the patient-centeredness of visit communication, [21] affected companion communication behaviors.…”

Patient and family empowerment as agents of ambulatory care safety and quality

“…None of the interventions in these reviews were designed to target or assess the behaviour of family members who routinely accompany patients to their medical visits alongside of patients, with the exception of the Patient-Companion Partnership Tool piloted in a recent randomised trial 26. The trial included a total of 64 individuals, representing 32 patients and their family visit companions.…”