Health Care Team (HCT)
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Families
Just as the most comprehensive and inclusive notion of the health care team must include the patient, for many of the same reasons, it must include the patient’s family. Although most patients retain final responsibility for making decisions regarding their own care, family members are often deeply involved in those decisions.
Family members are often an excellent source of information regarding the patient. They may be able to provide information on the patient’s medical situation and how he or she has been coping with the activities of daily living, including the psychological stress of his or her medical conditions. Getting accurate, unbiased information from family members may often require special sensitivity and good interviewing skills. The role of other health care team members, especially nursing staff, in eliciting such information should never be underestimated.
Family members can be an important resource by helping the team to communicate more effectively with the patient. Family can also assist by explaining cultural concerns or other obstacles the team may encounter in communicating with the patient. In cases where English is not a patient’s first language, bilingual family members can help the team overcome issues related to language barriers, although hospital translators should be called upon if needed for taking medical histories.
One of the most critical roles family members can play is in helping the patient to make a difficult decision. Patients who are faced with an essential but frightening procedure or course of treatment may be persuaded of the necessity of that treatment by a family member. Family members can also be an important source of emotional support for the patient throughout a difficult treatment or procedure.
Although family members are often an important source of support for a patient, it should not be assumed that decisions regarding the patient’s care will be made by, or shared with, the family. The family is not entitled to information about the patient without the patient’s knowledge and explicit consent. It is always important to ascertain from the patient what role he or she wishes family members to play in his or her care. It is of equal importance to respect and abide by that decision.
Situations may also arise in which family members may try to make health care-related decisions for a patient who is perfectly capable of making his or her own decisions. In such cases, it may be necessary for team members to communicate with the patient without family members present to ensure that the patient is not pressured or intimidated by the family.
In the case of the patient who has been determined to be mentally incompetent, family members may play an even more critical role. They often will have power of attorney or some other legal ability to make decisions on behalf of the patient. In such situations, the health care team should engage in regular and clear consultations with family members, recognizing and conveying to them their role as part of the team. In this way, family members can ensure that the best decisions are made for their loved one, while being relieved of some of the burden of making those critical decisions alone. Occasionally you may encounter a situation in which there may be differing opinions among the patient’s family members about which courses of treatment to pursue or abandon. It is desirable to try to reconcile these differences by providing accurate and clear information. However, if one of the family members has legal power of attorney, that family member’s decision must be respected.
