title: Missed opportunity? Caregiver participation in the clinical encounter. A videographic analysis.
abstract: OBJECTIVE
  Although the assistance of caregivers is critical to patients undertaking self-care, little is known about their participation in visits and involvement in decision making. We sought to examine this caregiver participation in shared decision making through videographic analysis.
  
  
  METHODS
  We identified video recordings from outpatient visits in which a healthcare professional, patient, and caregiver participated, drawn from five practice-based randomized trials testing the efficacy of decision aids vs. usual care. Two reviewers, working independently, coded videos to explore caregiver engagement in the clinical encounter, clinician facilitation of that engagement, and the influence of decision aids in the engagement process.
  
  
  RESULTS
  In most of the 37 videos coded, caregivers' participation was self-triggered. We saw no impact of the use of decision aids on caregiver participation. Clinicians did not address the caregivers' preferred level of involvement in decision making in any of the video recorded encounters analyzed.
  
  
  CONCLUSIONS
  In this analysis, most clinicians did not engage caregivers in outpatient visits for chronic care. While the use of decision aids improves communication between patient and clinician, they do not appear to affect caregiver involvement during consultations.
  
  
  CONCLUSIONS
  Research on the comparative effectiveness of ways to engage caregivers to optimize patient-important outcomes, including enhancing the shared decision making process is necessary.
authors.affiliation: Knowledge and Evaluation Research Unit Mayo Clinic, Rochester, USA. Electronic address: boehmer.kasey@mayo.edu.
authors.forename: Kasey R
authors.initials: KR
authors.lastname: Boehmer
authors.affiliation: Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Egginton
authors.affiliation: Knowledge and Evaluation Research Unit Mayo Clinic, Rochester, USA; Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Branda
authors.affiliation: College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kryworuchko
authors.affiliation: Knowledge and Evaluation Research Unit Mayo Clinic, Rochester, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Bodde
authors.affiliation: Knowledge and Evaluation Research Unit Mayo Clinic, Rochester, USA; Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Knowledge and Evaluation Research Unit Mayo Clinic, Rochester, USA; Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: LeBlanc
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D012648:Self Care; D014741:Video Recording
keywords: Caregivers; Chronic care; Comorbidity; Decision support; Shared decision making