When Healthcare Professionals Become Family Caregivers: Ambivalence on the Team

Barry J. Jacobs, PsyD, Crozer-Keystone Family Medicine Residency Program

Margaret Cotroneo, PhD, APRN-BC, University of Pennsylvania School of Nursing

David Seaburn, PhD, LMFT, Private Practice

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session #E4October 29, 201110:30 AM

Faculty Disclosure

We have not had any relevant financial relationships during the past 12 months.

Need/Practice Gap & Supporting Resources

What is the scientific basis for this talk?

--Review of literature on family caregiving and the challenges of healthcare professionals who are family caregivers

--Personal experiences of healthcare professionals and educators who have dealt with the collaborative healthcare

teams caring for their aging parents

Objectives

--Describe common experiences of healthcare professionals who become family caregivers in dealing with their own loved

ones’ collaborative healthcare teams--Describe the sources of treating professionals’ ambivalence

toward professionals/caregivers--Outline principles for guiding relationships between

professionals/caregivers and treating professionals to optimize patients’ well-being

--Suggest effective roles generally for family caregivers to play on the collaborative healthcare team

Expected Outcome

What do you plan for this talk to change in the participant’s practice?

--Learn guiding principles for working collaboratively with family caregivers who happen to be healthcare professionals

themselves--Increase awareness of the challenges for healthcare

professionals when caring for their own family members in the context of collaborative care

Learning Assessment

A learning assessment is required for CE credit.

Attention Presenters:Please incorporate audience interaction through a

brief Question & Answer period during or at the conclusion of your presentation.

This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy

accreditation requirements.

TODAY’S TALK

• Introduction: the burgeoning phenomenon of family caregiving; the challenges when the family caregiver is a healthcare professional

• Personal experiences• Guiding principles for caregiver-professionals:

agency and communion, advocacy, care coordination, colliding expectations

• Guiding principles for treating professionals• Discussion

INTRODUCTION• In part because of our aging population, more

Americans have chronic, disabling illnesses for which they need ongoing care from family members

• 65 million Americans provide some care during course of a given year; about 25 million regularly (i.e., daily)—numbers are growing

• Family caregivers of necessity interact with collaborative healthcare teams as part of tripartite model—patient-family caregiver-treating professionals

• Efficacy of that three-way partnership depends on trust, communication, common purpose

INTRO (cont.)

• The tripartite model becomes more complex and challenging when the family caregiver is a healthcare professional (caregiver-professional)

• Can affect the level of trust among the partners positively or negatively

• Can further communication or increase wariness and result in more guarded communication

• Frequently ambivalent relationship between caregiver-professional and treating professional; fear of criticism, ill-defined limits of advocacy

INTRO (cont.)

• American College of Physicians 2009 Position Paper on ethical guidelines for physician in working with patients and family caregivers:

• --Treating professional should draw boundaries so that caregiver-professional is expected to function as a family member, not a professional, in relation to the patient’s care

• --Caregiver-professional can serve as knowledgeable interpreter among patient, other family members and treating professionals

AGENCY & COMMUNION

Agency Communion

•

Connection

• Belonging

• Caring

• Autonomy

• Influence

• Self-determination

AGENCY/COMMUNION: A CONTINUUM

Ag

Com Overinvolved

Disengaged

Reactive

Passive

AGENCY INTERRUPTED

Physical functioning

Future

‘Get better’

Identity

Role loss

Meaning

COMMUNION INTERRUPTED

Communication

Labile affect

Conflict

Intimacy

Identity

Future

Integrating the healthcare team

REGARDING AGENCY

• Identify reasonable areas of influence.• Specify a family member who will have

primary responsibility for interacting with the healthcare team.

• Identify care responsibilities that can be assumed by family members.

REGARDING COMMUNION

• Arrange meetings between key family members and healthcare team representatives.

• Assess and address care needs of the primary caregiver and others.

• Maintain uniform/clear communication about diagnosis, prognosis and treatment planning.

TREATING PROFESSIONALS’ GUIDELINES

• Recognize own reactions/discomfort (e.g., wariness, defensiveness, withdrawal) when working with a family caregiver who is a healthcare professional

• Do unto others…: Accord respect for caregiver-professional’s special knowledge of illness, patient, family, home environment, etc.; communicate openly about details of treatment and prognosis, if patient allows it

TREATING PROS (cont.)

• Define partnership with limits: Encourage caregiver-professional to facilitate communication between treating professionals and patient/other family members but don’t give caregiver/professional right to dictate treatment plan

• Remember that no family member—not even one with professional credentials—has objective view of patient’s needs

• Don’t hesitate to offer caregiver-professional same support services you would any other family caregiver

Caregiver Expectations

Family Systems Considerations

Process of Multi-directed Partiality as a Tool in Coordination of Care

Process of Multi-directed Partiality as a Tool in Coordination of Care

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!