Physicians and Family Caregivers: Two Perspectives of Physicians' Roles in Long-Term Care

Objectives: We explored the roles of attending physicians of long-term care (LTC) residents in supporting their family caregivers (FCGs). Design: In this mixed-methods study, we conducted surveys and focus group interviews with physicians and FCGs. Setting and Participants: There were 78 FCGs and 18 physicians in the survey, and 18 FCGs and 9 physicians in the focus groups. They were recruited from 5 urban LTC settings. Results: Although 83.3% of physicians reported they had experience caring for FCGs, 71.8% of FCGs perceived they had not received support from the physicians. There was no statistically significant difference between the FCGs' and physicians' mean responses to the mirrored survey questions. Both groups gave similar ratings, means neutral and agree indicative of ambivalence, on physician's knowledge to identify FCGs who need assistance, ability to assess FCG stress, and aid those experiencing distress and needing advocacy. Analysis of the focus groups revealed the overarching theme: ambiguity about the LTC residents' physicians' role in supporting FCGs. Although physicians noted that residents and families come as a unit, there was ambivalence about the physician's role in supporting FCGs. FCG roles in LTC are also vague. There were 3 sub- themes: "accord on the surface"; "tension in the interface"; and "smoothing the relationship." Both groups thought FCG medical care was beyond the purview of the resident's physician. Physicians and FCGs provided different explanations for the tensions in the FCG/physician interface. Physicians attributed tension to FCG stress and inadequate knowledge, whereas FCGs thought physicians' communication could be improved. Suggestions to smooth the relationship were to align FCG expectations to reality of LTC and different staffing models. Conclusions and Implications: Family physicians, policy makers, and FCGs will need to work on polices to ensure LTC physicians' roles in supporting FCGs and FCGs' roles in LTC are delineated and supported. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.