Doctor-Patient Communication without Family Is Most Frequently Practiced in Patients with Malignant Tumors in Home Medical Care Settings

Abstract

Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

Clinical Background of Attendance by Patient's Family during Home Medical Care Visits

“…[1][2][3][4][5][6][7][8][9][10] The questionnaire was pretested with three families, in the presence of the researchers, to verify that the questions were comprehensible. Inclusion of survey items for the study was determined based on the hypotheses formulated through discussions among the authors.…”

“…These hypotheses were based on results of our previous qualitative studies on family communication in home medical care settings and other previous studies. [1][2][3][4][5][6][7][8][9][10] The questionnaire was pretested with three families, in the presence of the researchers, to verify that the questions were comprehensible. We thereby confirmed in advance that patients' families would understand all of the survey questions.…”

“…[5][6][7] In other words, it is relatively uncommon that the family does not accompany the patient during home healthcare visits. Therefore, the importance of home medical care is increasing, and enhancement of patient support at home is needed.…”

“…During typical home medical care visits, the physician or provider, the patient, and family member(s) are all present in the patient's room ; therefore, three-way communication between these parties is common. [5][6][7] In other words, it is relatively uncommon that the family does not accompany the patient during home healthcare visits. There are two types of family attendance at patient home medical care visits : one is "constant attendance" and the other is "attendance only when needed".…”

Families’ Sense of Discrepancy between the Explanations of Group Practice Doctors Providing Home Medical Care: A Cross-Sectional Study

“…The data sources for this study were medical records and completed questionnaires consisting of 53 questions, 15,16 a subset of which were analyzed in the current study. Information on basic patient characteristics was collected from the medical records, while information on patient background, family background, the caregiving situation, and doctors' medical interviewing skills were obtained from the questionnaires.…”