Review
Physician–patient–companion communication and decision-making: A systematic review of triadic medical consultations

https://doi.org/10.1016/j.pec.2012.11.007Get rights and content

Abstract

Objective

To systematically review quantitative and qualitative studies exploring physician–adult patient–adult companion (triadic) communication and/or decision-making within all medical encounters.

Methods

Studies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria.

Results

Of the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely.

Conclusion

Triadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed.

Practice implications

Preliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations.

Section snippets

Background

Literature on medical communication has primarily focused on physician–patient relations, leaving the influence of companions (e.g. spouses, family members, friends) relatively unexplored. Despite this, a diverse, albeit disjointed, literature base has begun to highlight the important role companions play during medical consultations.

Companions often accompany patients into the consultation, provide emotional, informational, or practical support [1], and participate in medical decision-making

Search strategy

A search of relevant databases (i.e. PsycINFO, MEDLINE, CINAHL, EMBASE, SCOPUS, Sociological Abstracts, Proquest Social Science Journals) was conducted. Search results were limited to articles published from 1950 to July 2011. Due to the varied nature of keywords in this field, a comprehensive list of search terms was developed (see Box 1). The returned search results were screened for irrelevant articles, review papers, and duplicates. An eligibility checklist was developed (see Box 2) to

Results

The search strategy produced 8409 references, most of which were not specifically relevant to the current topic but broadly related to illness and medical consultations. After deletion of duplicates and detailed assessment for eligibility, 52 studies were included (see Fig. 1).

Examination of selected studies revealed five primary themes, which were used to guide organization of review findings. Theme 1, patient, companion, and consultation characteristics discusses the features of triadic

Discussion

The current review has demonstrated that a diverse literature base exists within the field of triadic consultations. The majority of reviewed studies provided descriptive evidence about the characteristics of triadic consultations and accompanied patients/companions, or focused on participant preferences for companion involvement. However, studies were restricted by the lack of relevant theory describing triadic consultations. Currently, there are few applicable theories to assist in depicting

Ethical approval

Not required.

Acknowledgements

We gratefully acknowledge the Informed Medical Decisions Foundation for providing funds to support this project.

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