Institute of Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany.
Institute for History of Medicine and Science Studies, University of Luebeck, Luebeck, Germany.
Support Care Cancer. 2023 Jun 9;31(7):387. doi: 10.1007/s00520-023-07857-6.
Clinical communication and facilitating informed and sound medical decisions become challenging as patients age and suffer from age-associated impairments. Family caregivers are perceived as essential actors in addressing these challenges. Here, we explore physicians' perspectives on family caregivers' roles and their involvement in consultations and therapy decision-making situations of elderly cancer patients.
We examined 38 semi-structured interviews with physicians from different specialities (oncologists, non-oncology specialists, and general practitioners) in Germany who treated elderly cancer patients. Data were analyzed using reflexive thematic analysis.
We identified five general and distinct perspectives on the involvement of family caregivers in the therapy process. Family caregivers are seen as (1) translators of medical information; (2) providers of support for the patient; (3) providers of information about the patient; (4) stakeholders with relevant points of view regarding the treatment decision; or (5) individuals who have a disruptive influence on the consultation. The interviewed physicians rarely involved family caregivers closely in consultations.
Although physicians frequently attribute supportive roles to family caregivers, they rarely include them in consultations. Previous studies have found that a triadic setting is often better suited to agreeing upon a patient-centered and needs-based treatment decision for older cancer patients. We infer that physicians too rarely recognize the potential importance of family caregivers. Educators should further integrate family caregiver involvement and its implications in general medical education and professional training.
随着患者年龄的增长和出现与年龄相关的功能障碍，临床沟通和促进知情、合理的医疗决策变得具有挑战性。家庭照顾者被认为是应对这些挑战的重要角色。在这里，我们探讨了医生对家庭照顾者角色的看法，以及他们在老年癌症患者的咨询和治疗决策中的参与情况。
我们对德国不同专业（肿瘤学家、非肿瘤学专家和全科医生）的 38 名医生进行了半结构化访谈，他们治疗老年癌症患者。使用反思性主题分析对数据进行分析。
我们确定了医生对家庭照顾者参与治疗过程的五种一般而不同的看法。家庭照顾者被视为（1）医学信息的翻译者；（2）为患者提供支持的人；（3）为患者提供信息的人；（4）对治疗决策有相关观点的利益相关者；或（5）对咨询有干扰影响的人。接受采访的医生很少让家庭照顾者在咨询中密切参与。
尽管医生经常将支持性角色归因于家庭照顾者，但他们很少让他们参与咨询。先前的研究发现，对于老年癌症患者，三方设置通常更适合就以患者为中心和基于需求的治疗决策达成一致。我们推断医生也很少认识到家庭照顾者的潜在重要性。教育者应进一步将家庭照顾者的参与及其对普通医学教育和专业培训的影响纳入其中。
