Physician-elderly patient-companion communication in Japanese geriatric encounters: Roles and influence of the companion

The triadic encounter of physician, patient, and accompanying family is a common phenomenon in geriatrics, although previous research on communication in medical encounters has predominantly focused on dyadic interactions between physician and patient.;This study aimed to explore the triadic communication and roles of the companion in a sample of elderly patients aged 65 or over who visited a university affiliated geriatric clinic in Tokyo. Among the patients under continuous care of nine attending physicians, 63 accompanied patients and 82 unaccompanied patients were recruited. The consultation was audiotape recorded and analyzed using the RIAS with additional categories developed to code aspects of communication specific to triads.;In triadic encounters, companions made a significant contribution to the medical dialogue (the mean proportion of their talk: 22.2%) by providing information and asking questions to the physician, as well as facilitating patient's talk.;The patient's expectation of the companion's role during the medical visit, and the companion's intention regarding his/her role, were generally related to one another and the companion's behavior during the visit. Nevertheless, companions often anticipated playing a more direct communication role during the visit, including the provision of information and asking of questions, than patients expected of them (paired t-test: t = -4.34, p < .001). Inasmuch as patients may safeguard at least some communication roles as their own, and only reluctantly ascribe those functions to a companion, the companion's behavior was judged by patients as less helpful when expectations were at odds.;The presence of the companion in itself was not significantly associated with the patient's perception of patient-centeredness of the consultation, while factors associated with this perception differed in dyads and triads. After statistically controlling for consultation length and health status, in dyads the perception of patient-centeredness varied with how patient-centered the physician's communication was (z = 1.93, p = .053). In contrast, in triads the more the patient contributed directly to the communication (and the less the companion spoke), the more the visit was perceived as patient-centered (z = 2.06, p = .039). This was especially evident in shorter visits.;Further investigation is needed to explore the communication dynamics in triads and dyads, and its relation to patient outcomes.