Family-centred care and triadic medical consultations: Results from a pilot study

Heather L Rogers, Itxaso Respaldiza Berroeta, Margarita Lopez Rey, Mª Cruz Munoz Gonzalez, Sandra López Caballero, Ander Portugal Martínez, Amaia Rueda Merino, Jose Manuel Vidal Arboiro, Aitor García Moreno, Juan Jose Rodriguez Salvador

Keywords: Family-centred care, person-centred care, triadic medical consultations

Background:
The presence of a family member in the primary care visit is socially and culturally acceptable in Spain. 20%-40% of consultations include a family member.

Research questions:
What are the perceptions of health care professionals and patients regarding family-centred care (FCC)? What do FCC consultations look like?

Method:
94 physicians, pediatricians, nurse, midwives, and nurse assistants with at least 2 years of experience in primary care (PC) were recruited from 5 health centers in Basque Country, Spain. They completed modified Person-Centred Practice Inventory-Staff and Family Nurse Caring Belief Scale. 165 patients were recruited from these centers using purposeful sampling stratified by age and gender. They completed a questionnaire to measure person- and FCC. In a follow-on study (data collection on-going), physicians complete a worksheet regarding their daily consultations, recording the patient's age, the patient's gender, the reason for consultation (text and check box), acute vs. chronic condition, was information (if any) about the family was gathered, was the patient accompanied by someone, relationship to the patient, how was the family member involved in the consultation (if at all), and total duration of the consultation. The medical record will be reviewed for written annotation/documentation about the family.

Results:
99% (n=93) of the health professionals agreed/strongly agreed with statements regarding FCC behaviors, 77%(n=72) with family as a resource, and 63%(n=59) with professional responsibility to the family. Total score, FCC Behaviors, and Role of the family were negatively associated with years in PC (p’s<0.05) and tended to be higher in nurses than physicians (p’s<0.07). Of the 165 patients, 37%(n=61) usually attended medical consultations with a family member. Half of those (n=36;21.8% of the sample) came accompanied. Almost half (47%;n=15/32) rated FCC with the maximum score, with means of “very good” on each item.

Conclusions:
FCC is important to both healthcare professionals and patients in primary care.

Points for discussion:
How often is family-centred care practiced in your center/consultations?

How often do you orient your exploration of the patient as a person towards the family?

If family members are present in the consultation, how do you engage them in the visit?