Communication participation in primary care visits: the physician, patient, caregiver triad: Presenter(s): Leah Karliner, University of California San Francisco, United States

Family caregivers often accompany older patients to medical visits. To optimize care, it is important to understand communication during these triadic visits. In this study we examine the presence of a caregiver on the amount of biomedical and psychosocial-emotional talk during primary care visits. We leveraged a dataset of audiotaped primary care visits with 189 older ethnically Chinese and Latinx patients. We classified each visit according to a family caregiver’s presence (‘accompanied’) or absence (‘unaccompanied’). We used the Roter Interaction Analysis System to analyze the audiotapes, identifying and comparing frequency of biomedical and psychosocial-emotional communication elements between accompanied and unaccompanied visits. For accompanied visits, we first excluded and then included caregiver talk. Of the 189 visits, 60 (32%) were accompanied. Patients who were accompanied were on average older (77.5 vs. 67.2; p<.001), and more often had limited English proficiency (87% vs 62%; p<.001). Half (n=96) of all visits were fully, and 15 partially, language concordant in Chinese, English or Spanish; 66 visits had a professional interpreter present. For 11 (18%) accompanied visits, caregivers acted as interpreters. Doctors did not vary the frequency of biomedical or psychosocial-emotional talk between accompanied and unaccompanied visits. Patients in accompanied visits had less of every talk element compared with patients in unaccompanied visits, including medical information, medical questions, psychosocial and lifestyle information, psychosocial questions, and emotional talk (all p<.02). When adding caregiver talk, there was no longer a difference between accompanied and unaccompanied visits for any element except medical questions which was higher for accompanied visits (p=.02). Having a caregiver present did not change physician communication behavior. Caregivers were active participants for both biomedical and psychosocial-emotional communication. It remains unclear the best ways to elicit patients’ communication preferences and to balance communication with patients and their caregivers during visits.