Examining actual behaviours occurring in triadic (oncologist-patient-family caregiver) consultations: Analyses of audio-taped oncology consultations — ASN Events
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  3. Examining actual behaviours occurring in triadic (oncologist-patient-family caregiver) consultations: Analyses of audio-taped oncology consultations

Examining actual behaviours occurring in triadic (oncologist-patient-family caregiver) consultations: Analyses of audio-taped oncology consultations (#79)

Ilona Juraskova 1 , Rebekah Laidsaar-Powell 1 , Phyllis Butow 1 2 , Stella Bu 1 , Rachel Dear 1 , Joe Coll 2
  1. Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The School of Psychology, The University of Sydney, Sydney, NSW , Australia
  2. Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW

Aims
Limited studies have assessed actual behaviours of triadic (oncologist-patient-family) consultation participants. The current study aimed to: i) rigorously develop a TRIadic Oncology (TRIO) coding system capturing communication and decision-making behaviours of family caregivers and family-relevant behaviours of oncologists and patients; and ii) apply the TRIO coding system to initial cancer consultations.
Methods
Based on the evidence base, a new triadic interaction analysis (TRIO) coding system was developed. It included 4 global role items to assess family activity levels (passive, supportive, active, and dominant) across four consultation phases; 24 oncologist behaviour items; 14 patient behaviour items; and 38 family caregiver behaviour items. The TRIO coding system was applied to 72 audiotaped medical/radiation oncology consultations where a family caregiver was present, collected from 2 previous studies.
Results
Oncologists rarely engaged in rapport building with family caregivers (18%) or asked family questions (25%), but were typically fully responsive to family caregiver questions (90%). No oncologists (0%) established the family’s reason for attending or established patient/family preferences for family involvement in decision-making. A high proportion of oncologists interrupted the family caregiver (58%). Generalised estimated equations found that more experienced oncologists were more likely to interrupt a family caregiver (OR 1.793, p=<.001) and oncologists were more likely to interrupt a family caregiver who had corrected or disagreed with the patient (OR=5.468, p=<.01). Many patients asked their family caregiver a question (42%) but few elicited the family caregiver’s decision preferences (4%). High proportions of family caregivers asked treatment decision questions (71%), but also interrupted the patient (54%) and oncologist (42%).
Conclusions
This study provides novel insights into the complex nature of family involvement in consultations. The findings highlight a number of potentially positive family-focused consultation behaviours such as question asking and responsiveness and areas for improvement such as oncologist rapport building, preference clarification, and minimisation of interruptions.

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