In this era of fragmented care, family members rarely get to know even the names of the many clinicians who care for elderly patients with impaired cognition, according to a report by researchers with the Regenstrief Institute and Indiana University School of Medicine.
Even a physician or nurse who was especially supportive or helpful to the family might see the family member only once or twice. Family members usually remembered that the person was a physician, nurse or social worker but often apologized for being unable to remember the person’s name.
"The patient’s care is often passed from one doctor or nurse to the next as shifts change," Regenstrief Institute investigator Alexia Torke, MD, MS, assistant professor of medicine at the IU School o f Medicine, said in a news release. "The patient may be getting high-quality medical care, but it often is very fragmented."
When hospitalized older adults have impaired cognition, family members or other surrogates must communicate with clinicians to make medical decisions and provide information about the patient. In interviews conducted for the study, surrogate decision-makers were clear about the kind of support they needed: frequent communication, detailed information and expressions of emotional support from the healthcare providers.
Surrogates said they appreciated this support even when it often was delivered by clinicians they hardly knew. Surrogates reported feeling distress about having to struggle for information or for frequent updates from the clinicians.
"Surrogate decision-makers are under a lot of stress from their loved one’s illness, and they crave both information and support from those caring for their family member in the hospital," Torke said.
"Surrogates want regular and coordinated updates from someone; it doesn’t have to be the physician. The healthcare system will have to change to meet this need, and in future studies we will be looking at how this can be accomplished."
In a 2009 survey of physicians, Torke found that communication with surrogates often is delayed or infrequent. The 2012 survey of surrogates suggests that delays or lack of frequency of communication may cause distress for surrogates.
The study authors surveyed 35 surrogates who recently made a major medical decision for a hospitalized older adults. Of those surveyed, 80% were female, 56% were African-American and 44% were white. Responses did not vary by gender or race.
Surrogates’ relationships with clinicians often were fragmented and brief, according to survey responses. "Even the presence of hospitalists may not make a real difference," Torke said. "They work in shifts and are unlikely to have had a relationship with the patient or family prior to admission."
The study, "Communicating With Clinicians: The Experiences of Surrogate Decision-Makers for Hospitalized Older Adults," is scheduled for publication in the August issue of the Journal of the American Geriatrics Society. To read the abstract and access the study via subscription or purchase, visit http://bit.ly/Mjq6t1.
Even a physician or nurse who was especially supportive or helpful to the family might see the family member only once or twice. Family members usually remembered that the person was a physician, nurse or social worker but often apologized for being unable to remember the person’s name.
"The patient’s care is often passed from one doctor or nurse to the next as shifts change," Regenstrief Institute investigator Alexia Torke, MD, MS, assistant professor of medicine at the IU School o f Medicine, said in a news release. "The patient may be getting high-quality medical care, but it often is very fragmented."
When hospitalized older adults have impaired cognition, family members or other surrogates must communicate with clinicians to make medical decisions and provide information about the patient. In interviews conducted for the study, surrogate decision-makers were clear about the kind of support they needed: frequent communication, detailed information and expressions of emotional support from the healthcare providers.
Surrogates said they appreciated this support even when it often was delivered by clinicians they hardly knew. Surrogates reported feeling distress about having to struggle for information or for frequent updates from the clinicians.
"Surrogate decision-makers are under a lot of stress from their loved one’s illness, and they crave both information and support from those caring for their family member in the hospital," Torke said.
"Surrogates want regular and coordinated updates from someone; it doesn’t have to be the physician. The healthcare system will have to change to meet this need, and in future studies we will be looking at how this can be accomplished."
In a 2009 survey of physicians, Torke found that communication with surrogates often is delayed or infrequent. The 2012 survey of surrogates suggests that delays or lack of frequency of communication may cause distress for surrogates.
The study authors surveyed 35 surrogates who recently made a major medical decision for a hospitalized older adults. Of those surveyed, 80% were female, 56% were African-American and 44% were white. Responses did not vary by gender or race.
Surrogates’ relationships with clinicians often were fragmented and brief, according to survey responses. "Even the presence of hospitalists may not make a real difference," Torke said. "They work in shifts and are unlikely to have had a relationship with the patient or family prior to admission."
The study, "Communicating With Clinicians: The Experiences of Surrogate Decision-Makers for Hospitalized Older Adults," is scheduled for publication in the August issue of the Journal of the American Geriatrics Society. To read the abstract and access the study via subscription or purchase, visit http://bit.ly/Mjq6t1.
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