"We need to bring them out from the shadows:" A qualitative study of safety net physician leaders' perspectives on caregivers

Abstract

Objective: To explore physician leaders' perspectives on processes and priorities for engaging with caregivers in their clinical practices as well as within their safety net health systems.

Methods: We conducted in-depth semi-structured interviews with primary care physicians in care management leadership at three California safety net health systems. Interviews explored physicians' experiences managing medically and socially complex patients with caregivers. Using thematic analysis, two qualitative researchers independently analyzed interview transcripts and established consensus with the broader research team through iterative input to derive major themes.

Results: Fifteen physicians completed interviews. Nine participants were women, 8 were White and 10 reported Spanish language proficiency. Participant interviews generated six major themes: challenges uncovering caregiver identities, recognizing variation in caregivers' roles, adapting visit communication strategies to include caregivers, engaging caregivers in patient care, and caring for the caregiver.

Conclusions: Engaging caregivers is challenging given the limited recognition of caregiver involvement in patient care by health systems. Adapting visit communication to include caregivers requires bridging language and literacy barriers.

Practice implications: Developing mechanisms to enable the consistent identification of patients' caregivers, facilitate ongoing communication with caregivers, and extend support for them could improve outcomes for vulnerable patients and their families.