Companions often speak on behalf of patients during discussions of cancer treatment and prognosis, even when the patient is present and capable of speaking on his or her own behalf, according to a new study by the Wilmot Cancer Institute and UR Family Medicine.
Sometimes the situation is so extreme that researchers refer to it as “pseudo-surrogacy,” when the companion claims to represent the patient’s views. This situation, however, cannot provide a complete picture of the patient’s own perspective. For example, a physician might say to the patient, “May I ask what are your thoughts about hospice? What do you think hospice services mean?” And the companion jumps in to answer: “Well, I think she thinks it means the end.”
Benjamin Mazer, a fourth-year medical student at the University of Rochester School of Medicine and Dentistry, and Ronald Epstein, M.D., professor of Family Medicine, Oncology, and director of the Center for Communication and Disparities Research, led the study. It was published recently in the journal, Patient Education and Counseling.
Using audio-recorded encounters from 2011 and 2012 between oncologists, patients, and family members, researchers transcribed the tapes and developed a coding system to assign to companion utterances. Codes included instances in which a companion was speaking on behalf of the patient, speaking with, speaking as, or speaking for the patient based on conversations the two had before the doctor’s visit, for example.
In modern medical practice, the physician-patient relationship usually involves a third party. Although preliminary, researchers said their study might guide family members to be better advocates by avoiding “pseudo-surrogacy,” and guide physicians to recognize behaviors that silence patients’ voices. Read more here.
Leslie Orr |
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