As healthcare workers, communicating with your patient’s family members and getting them to actively participate in patient care is an important aspect of the work we do. After all, family members are the ones who spend the most time with your patient and will understand their loved one best. Involving them in the care process is key to providing a holistic recovery experience for your care recipients.
Engaged family members are ones who have a comprehensive understanding of the patient’s conditions, experiences, preferences, and the care they receive, and play an active part in various aspects of the patient’s care, including decision-making.
Benefits of family involvement in patient-centred care
The involvement of patients and their family members in the care process can provide better outcomes.
Healthcare workers are often responsible for multiple patients. This means that professional caregivers may not be there for a patient 24/7. In times when the healthcare worker is away, family members who are well-informed of the patient’s condition and the care they need can seamlessly step in to ensure care continuity.
Having family members who are directly involved in caregiving can also help to reduce reliance on professional caregivers and the associated healthcare costs, without compromising on the quality of care the patient receives. Furthermore, they are more aware of the habits and lifestyle preferences of their loved ones, which can be important in helping care recipients feel more at ease as they grow accustomed to the care delivery process.
Besides direct involvement in patient care, having a family member present at medical visits can facilitate communication with the doctor and improve patient self-management behaviours. Family members may also be able to provide information such as medical history or lifestyle behaviours that the patients themselves may have missed out on.
On top of providing physical care, having the support of family members when one is facing health issues can be a source of strength and may improve psychological well-being as well.
Common challenges faced by caregivers and healthcare staff in involving family members
1. Managing expectations and defensive behaviours
Often, family members are unaware of the benefit of family involvement in patient care, especially the less tangible effects. Furthermore, in the presence of a healthcare provider, they might have the expectation that the healthcare professional will be fully responsible for their loved one’s care needs and therefore take a more hands-off approach in the care delivery process.
However, family members may know certain information about the patient that can be useful knowledge in making medical decisions and the care planning process. Family involvement also has various other intangible benefits on the overall well-being of the patient, such as helping them feel more at ease and providing a sense of comfort and familiarity that is only possible with loved ones.
2. Communicating with multiple family members
When multiple family members are involved, healthcare providers often have to repeat the same information which is inefficient and can result in frustration, confusion, and friction among the parties involved. This conflict and confusion may arise in various situations, such as when a healthcare provider speaks to a demanding family member, when different healthcare providers speak to different family members, and when family members share information among themselves.
For example, the patient’s brother may have spoken with a doctor in the morning, but then receives a different but more current update from another family member later in the day which conflicts with his earlier knowledge, leading to confusion and conflict.
3. Navigating different family dynamics
Family dynamics are complex, and healthcare providers may not be fully aware of the specific family’s interactions and relationships with the patient involved. There may be situations where a family member asks a healthcare provider about the patient’s condition, but the patient has made known that they do not want to share certain information with them. This can give rise to conflict between the healthcare provider and the family member, and also cause stress to the patient.
4. Family involvement vs. Patient’s autonomy
At what point does family involvement infringe on a patient’s autonomy? There has been considerable debate on whether involving family members in medical decisions could place undue pressure on the patient and infringe on their autonomy, since family members may have divergent values and priorities from those of the patient.
The level of family involvement in decision-making varies greatly for every case. However, in the absence of abuse and neglect, including family members in the medical decision-making process usually does more good than harm. Having your loved ones around can help you consider more factors and formulate a more well-rounded decision.
5. Healthcare institutions’ visitor policies
Family caregivers often have to juggle multiple responsibilities, like full-time jobs and caring for children. This limits the time they can visit their loved ones at healthcare institutions. Given that healthcare institutions often have strict visitor policies such as fixed visiting hours and stay-over restrictions, it can be difficult for family caregivers with less flexible hours to find a time slot where they can visit their loved ones in care facilities.
This also poses a challenge for professional caregivers to speak with family members and get them involved in care delivery, as in-person communication is limited.
6. Answering family members’ questions
When a loved one is unwell, it is only natural for family members to be concerned and have many questions about the patient’s well-being. Professional caregivers may not always have a definite answer to these questions, and the challenge arises from giving a tactful answer that does not overpromise but also eases the family members’ worries.
How can you better involve family members in the care process?
Professional caregivers need to view family members from an empathetic lens and adopt a holistic approach when encouraging active participation in patient care.
Here are some tips and strategies:
1. Make family members feel comfortable
In general. ensuring that the patient and family members are comfortable with the setting and your presence can make them more receptive to two-way communication. Ways that you can do so include:
- Read the patient’s chart to stay updated with their current condition and treatment before you step into their room, which will help you to be more prepared to share about their condition.
- When entering a room, make eye contact with the patient as well as their family members, and introduce your name, role, and what you are here for.
- Make the setting comfortable for both the patient and family by ensuring there is adequate equipment and furniture, like walking frames and chairs, for them to rest.
2. Practise active listening
As caregivers, we may be eager to share about the patient’s condition with the family and instruct them on the best way to care for their loved ones. However, a key part of communication is active listening.
In times of stress, different people react differently. Family members or even patients themselves may seem to ramble about their concerns and repeat themselves, while others may clam up and become silent. As professional caregivers and healthcare staff, we need to do our part to alleviate their anxiety regardless of how they communicate their concerns.
Here are ways that you can practise active listening during these conversations:
- When a family member is talking, do not interrupt. Instead, it is often best to listen to their viewpoints first.
- Summarise and repeat back when necessary to validate that you understand the message they are conveying.
- If a family member is not sharing much or you need more information, ask open-ended questions and try to help them articulate their concerns and thoughts.
There may be times when the patient or family members share with you their discomfort with the way things are done, even though you may feel that it is the best way to do so from the perspective of a medical professional. During these times, it is critical to keep in mind that family members often know their loved ones best and their concerns are valid and important in helping us deliver personalised care.
In such situations, acknowledge and thank them for bringing up the issue, and address their concerns seriously. This will encourage them to participate more actively in patient care and improve the individual’s well-being and quality of care.
3. Educate the patient and family
When sharing about the patient’s condition and key care information, here are some tips that professional caregivers can follow:
- Speak slowly and clearly to help others understand and avoid having to ask you to repeat yourself
- Use plain language and steer clear of complex medical jargon. If complex medical terms are mentioned, be sure to break them down and explain them in simple-to-understand terms.
- Ensure that the patient and family are always up-to-date with the patient’s latest condition and treatment. Receiving sufficient and timely information can help to alleviate stress, ensure that everyone is aware and aligned, and provide an opportunity to discuss patient care plans.
- Be honest and tactful. Do not lie about a patient’s condition just to ease their family members’ worries. Convey the information honestly but tactfully. It is not always easy as families may be sad, angry or defensive, so be prepared to comfort them as well.
- Encourage the patient and family to ask questions. Let them know the various channels they can reach you, so they can communicate with you in the form that they are most comfortable with. You can also establish and decide on a preferred form of communication with the family for regular correspondence and updates on the patient’s condition.
- Slow down and invite the patient and family members to take notes if necessary.
These tips should help to prevent miscommunication and make patients and family members more open to collaborating and communicating with you and the medical team.
4. Ensure patient privacy
While we may want to share with family members how their loved one is doing and get their input, we must respect patient privacy.
Before sharing with family members, make sure to first check with the patient what types of information they are comfortable sharing with the family member involved. In addition, you can confirm with the patient who the primary caregiver is and directly liaise with them and get them to disseminate the information to other family members involved. By doing so, you can avoid having to repeat the same information to different family members and prevent potential conflict and confusion due to miscommunication.
Getting family members to actively participate in patient care is no mean feat, especially since every patient and family interaction is unique. Now that you have a better understanding of the challenges you may face and strategies to counter them, we hope that it will help you provide more holistic and personalised care to the patients under your care.
- Cené, C. W., Johnson, B. H., Wells, N., Baker, B., Davis, R., & Turchi, R. (2016). A Narrative Review of Patient and Family Engagement: The “Foundation” of the Medical “Home”. Medical care, 54(7), 697–705. https://doi.org/10.1097/MLR.0000000000000548