Background: Elderly inpatients often require the support of family and informal caregivers at transitions and yet adequacy of communication between hospital physicians and members of the patient’s social support is poorly studied.
Methods: Mixed methodology survey of patients, their preferred social support member, and physicians as part of a communication quality improvement initiative on the Acute Care for the Elder Unit of an academic medical center. Participants were 41 geriatric patients, 34 support members (family), and 5 resident physicians. Qualitative and quantitative data was collected on perceived importance of communication between hospital physicians and family at time of admission and discharge and desired frequency of additional communication on intervening hospital days along with communication satisfaction during hospitalization. Between each group, paired dichotomized responses on admission and discharge were compared using paired sign test. Other days of hospitalization were compared using Wilcoxon signed rank test.
Results: High levels of importance was assigned to communication between physicians and the patient’s family on admission and discharge. However, significant discrepancy was observed between the perceptions of each of these groups for more than 1 in 10 cases. Only 19% of expectations for communication were concordant between all groups for other days of hospitalization. There was a statistically significant difference (mean difference 0.63; p=0.001) in family-physician comparison and a trend for patient-physician comparison. The most common desired frequency of communication between the physician and the family was “any time there has been a change in condition or plan” with 34% (14/41) of patients and 53% (18/34) of family selecting this option. However, physicians most commonly selected “only when the doctor feels it is necessary” selecting this option 50% of the time (19/38). Major discordance in communication preferences was observed. For instance, 29% (10/34) of family reported wanting to hear from the physician every day even if there had been no change in condition or plan but in only one of these cases did the physician also report believing this should be the frequency of communication. 1 in 8 members of the patient’s social support network reported dissatisfaction with communication. Comments often referenced the need for honesty, clarity, and transparency especially around prognosis or changes in condition. At times patients reported wanting to maintain control of information although this was paired with concern on part of family about intentional, or unintentional, information attrition when not hearing directly from the physicians.Family frequently referenced themes relating to needing information for effective planning of the upcoming transition out of the hospital and future prognosis. Family often referred to a sense of anxiety of being left out leaving them with limited ability to contribute to informed decision making. The unique need in the medical care of the elderly for the physicians to involve the patient’s social support was raised frequently by family.
Conclusions: Effective care of elderly inpatients requires engagement of family, friends, and caregivers in a manner that respects individual patient’s autonomy and communication preferences. Efforts to improve care for inpatient elderly should attend to communication with members of the patient’s social support network as well as the patients themselves.