title: Consultation etiquette in general practice: a qualitative study of what makes it different for lay cancer caregivers.
abstract: BACKGROUND
  It is commonplace for lay caregivers to overlook their own health concerns when supporting someone with advanced cancer. During this time, caregivers' needs as patients are often marginalised by health professionals, including General Practitioners (GPs), who may miss the breadth of caregivers' needs by focusing on the practicalities of caregiving. GPs traditionally rely on patients to raise their concerns, and then respond to these concerns, but caregivers as patients may be disinclined to cue their GP. The norms of engagement when caregivers consult their GP are less defined, and how they interact with their GP regarding their own health is under-explored. This sub-study investigates the norms, assumptions and subtleties which govern caregiver-GP consultations, and explores factors affecting their interaction regarding caregivers' own health concerns.
  
  
  METHODS
  We conducted semi-structured interviews with six lay caregivers and 19 health professionals in Brisbane, Australia, and analyzed the interview transcripts thematically.
  
  
  RESULTS
  Traditional norms of engagement are subjected to assumptions and expectations which caregivers and GPs bring to the consultation. Practice pressures also influence both parties' capacity and willingness to discuss caregivers' health. Nonetheless, some GPs monitor caregivers' health opportunistically. Their interaction is enhanced by the quality of the caregiver-GP relationship and by the GP's skills.
  
  
  CONCLUSIONS
  Caregivers are caught in a paradox whereby their health needs may become subsumed by the care recipient's needs in a setting where patient needs are normally scrutinised and supported. Caregivers may not raise their health concerns with their GP, who instead may need to cue them that it is timely and safe to do so. The routine use of a prompt may help to address caregivers' needs systematically, but it needs to be complemented by GPs' desire and capacity to engage with patients in a caregiving role. The potential difference GPs can make to the health of these patients is substantial.
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospitals, Herston, Queensland 4006, Australia. l.burridge@uq.edu.au
authors.forename: Letitia H
authors.initials: LH
authors.lastname: Burridge
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Mitchell
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.forename: Afaf
authors.initials: A
authors.lastname: Girgis
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D005260:Female; D058005:General Practitioners / Q000523:psychology* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009369:Neoplasms; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D036301:Qualitative Research; D011793:Queensland; D012944:Social Support