Medicines

Treating a patient means negotiating with their family


Upcoming guidelines on the management of sometimes complex, triadic interactions between oncology patients, family members and clinicians will help improve patient care and outcomes.

Associate Professor Ilona Juraskova, from the University of Sydney’s Centre for Medical Psychology and Evidence-based Decision-making, told the inaugural Victorian Comprehensive Cancer Care Research Conference that family involvement in consultations had been a neglected area within doctor-patient communication.

However a seven-year program of research had confirmed the important role that family members played as well as the complexity they could add to clinical encounters.

“Family caregivers play a big part in helping patients make medical decisions and supporting patients throughout their cancer journey,” she said.

“However family caregivers can also be adversely affected by this role. They are not necessarily prepared and can be more effective in their caregiving role if we can involve them, acknowledge their role and give them affirmation when we interact with them during or outside clinical consultations.”

Associate Professor Juraskova told the limbic that clinicians largely welcomed family involvement but wanted help in navigating the more complex and challenging situations.

She said one of the most common and complicated situations involved conflicting treatment preferences between patients and family members.

“The family member might not agree with the type of treatment – for example additional treatment like chemotherapy on top of surgery – while the patient is happy with combined treatment.”

“At a more advanced stage, patients might be more interested in quality of life and want to cease treatment while a family member might find it hard to come to terms with that.”

She said a guiding principle underpinning many of their recommendations was respect and empathy for the underlying emotions at play.

The evidence-based guidelines, developed with extensive input from clinicians and consumers, are supported by training videos which role model effective triadic communication in different scenarios.

Associate Professor Juraskova added that communication skills could be taught – ideally, early in the clinician’s training.

“You are not necessarily born a great communicator and seniority or experience does not equate with great communication skills.”

“Communication is at the core of providing effective and high quality care. It can prevent a lot of suffering and misunderstanding,” she added.

However there was also a role for psychologists as mediators in some clinical situations.

“Patient wishes need to be respected but you don’t want to dismiss family wishes either so that’s where psychologists may play a role. There are definitely situations where one of the strategies is to refer the patient for psychological help.”

Associate Professor Juraskova said the guidelines, coauthored by Dr Rebekah Laidsaar-Powell and Professor Phyllis Butow, would soon be published in Patient Education and Counselling.

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