Patient mental health overlooked by physician when a family member is present

May 30, 2012

Existing research shows that it is beneficial to have a loved one present when visiting the doctor, but a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health suggests the opposite may be true for older adults suffering from poor mental health. They examined whether companion presence in routine primary care visits helps or hinders physician visit processes and found that older adults with poor mental health function may experience more communication challenges in the form of shorter visits and less patient-centered communication. The results are featured in the June 2012 issue of Journal of General Internal Medicine.

"Despite a growing body of research that a family companion has favorable implications for patient- centered processes and communication during medical visits, what remains unclear is the effect on medical visits that involve discussion of a potentially stigmatizing condition such as mental health," said Jennifer Wolff, PhD, lead author of the study and an associate professor with the Bloomberg School's Department of Health Policy and Management. "Our study found that when patients with poor mental health were accompanied by a family companion, patients engaged in less psychosocial information-giving; physicians engaged in less question-asking and partnership-building and both patients and physicians contributed more task-oriented and biomedical dialogue which is indicative of less patient-centered communication."

Using an observational study, researchers examined primary care visits of accompanied and unaccompanied patients ages 65 and older. Medical-visit communications were audio recorded and coded using the Roter Interactional Analysis System. The authors evaluated visit duration, patient-companion verbal activity, and patient-centered communication, and adjusted for differences in accompanied and unaccompanied patients' age, gender, race and physical function. The researchers examined study participants' self reported mental health and determined communication challenges were amplified in the lowest functioning mental health subgroup. In addition, medical visits were 2.3 minutes longer when patients with good mental health were accompanied.

"Patient-centered care remains the ideal patient provider paradigm," said Debra Roter, DrPH, MPH, co-author of the study and a professor with the Bloomberg School's Department of Health, Behavior and Society. "Our findings speak to the need for greater attention to primary care infrastructure to support delivery of mental health care, as well as research to identify best practice strategies for integration of family in routine medical practice. New models of inter-professionalism which acknowledge family in the decision-making environment, explicit recognition of family in national health care quality deliberation and growing evidence that family companions are commonly present and directly involved in medical-visit dialogue make this a topic ripe for further inquiry."
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"Older Adults' Mental Health Function and Patient-Centered Care: Does the Presence of a Family Companion Help or Hinder Communication?" was written by Jennifer L. Wolff and Debra L. Roter.

The research was supported in part by the National Institute of Mental Health.

Johns Hopkins University Bloomberg School of Public Health

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