Involving relatives in consultations for patients with long-term illnesses: Nurses and physicians' experiences.

Abstract

Due to the major changes occurring in the demographic composition of the world's population, the number of older individuals is increasing, which puts pressure on the healthcare systems in many different countries. The involvement of volunteers and family members may become necessary to fulfil a patient's needs for follow-up treatments and long-term care in their homes. This study aimed to explore how nurses and physicians experienced and addressed ethical challenges when they dealt with relatives in what have traditionally been one-on-one consultations at two Norwegian hospital outpatient clinics. A total of eight nurses and two physicians from two different hospitals participated in individual in-depth interviews. The transcribed interviews were analysed using an eclectic approach called 'bricolage' inspired by Kvale and Brinkmann. We combined cross-case thematic and theoretical normative analyses. The principles of voluntariness, confidentiality, withdrawal and anonymity were respected throughout the research process. In addition, the Norwegian Social Science Data Services approved this study. The findings showed that respect for a patient's autonomy was used as an argument for delimiting the relatives' access to the patient's consultations. We found that there were insufficient routines in place for inviting and involving relatives in the patient consultations in the outpatient clinics. The traditional Western attitudes towards the principles of patient autonomy will likely be challenged due to the growing need for family involvement in the care of a patient in the future. This study's description of the nurses and physicians' interpretations of 'patient autonomy' as a phenomenon uncover the need for systematic ethical deliberation in the clinical setting. On an organisational level, there is a strong indication of the need to discuss the routines that are in place to invite the next of kin to participate in such patient's healthcare consultations.