Trust Between Physicians and Family Caregivers: Qualitative Insights from Three Family‐Centered Academic Medical Centers

Abstract

AbstractFamily caregivers increasingly support health care tasks but are not meaningfully integrated into the health care setting in consistent or standard way. Previous literature has established the importance of trust in patient‐clinician relationships; yet, little is known about family caregiver‐clinician trust, and further, how and when to integrate family caregivers into health care teams so they can better support their relative. This study examined a) how physicians assess and perceive trust with family caregivers, b) the role of culture in trust dynamics, and c) facilitators and barriers to integrating caregivers into health care teams. We conducted twenty qualitative interviews with physicians in geriatrics (n=9) and oncology/hematology (n=11) between January–March 2021. Physicians assess caregivers' competence, reliability/dependability, and fidelity. They assess caregivers' engagement (e.g., asking questions, verbal and non‐verbal cues) to determine whether caregivers trust them. Physicians in our study trust other physicians more than caregivers in certain situations (e.g., for objective information, data) while they trust caregivers more than other physicians for information that requires familiarity and time with the patient (e.g., observations in the home environment). When supporting patients from diverse cultural backgrounds, physicians often rely upon caregivers to provide contextual information about relevant cultural norms. Integrating caregivers into the care team early—when the patient‐caregiver relationship is strong—can be critical to providing effective patient care. Technology can facilitate the trust‐building process to further support caregiver integration. Building trust‐driven partnerships between physicians and family caregivers could be critical for effective communication of important information to support patient care. Guidelines and policies related to telehealth, discussions between physicians and caregivers, tools to screen caregivers for skills and caregiver burden, and reimbursements for partnering with caregivers are important priorities for supporting caregivers and patient care.