Research in geriatric primary care visits has shown that companions are present in approximately one-fourth of geriatric primary care visits, although little is known about their impact on communication and decision-making in the medical context.; Decision-making by patients and companions and autonomy-related behaviors by companions (n = 93) were examined using videotapes of a cross-sectional sample of geriatric primary care visits with companions. Patients in this sample range in age from 65–95 years and are mostly white (n = 73, 79%) and female (n = 67, 72%). Companions are spouses (n = 42, 46%), adult children (n = 33, 36%), or other relatives and friends (n = 15, 16%) of patients.; Decisions in the medical visit were examined using an autonomy-based framework modified from prior research, and autonomy-related behaviors of companions throughout the medical visits were investigated as well. Autonomy-enhancing behaviors include facilitating patient understanding, facilitating patient involvement, and facilitating doctor understanding. Autonomy-detracting behaviors are being controlling toward the patient and building alliance with the physician.; There are 301 decisions in 93 visits (mean = 3.2 decisions per visits), while 10% of the visits have no decisions present. The average number of elements of informed decision-making present is 3.5 (out of a possible 7), with physicians engaging in the most elements (3.2), patients less (2.0), and companions the least (mean = 1.0). Companions are primarily engaged in behaviors that enhance the patient's autonomy by providing information to both doctor and patient. Companions' facilitating patient involvement was strongly related to patient activity in decision-making. Patients whose companions facilitate their involvement in the medical visit are more than 3 times as likely to be active in decision-making as patients whose companions do not assist in this manner (OR 3.5, CI 1.4–8.7, p .01). Companions who facilitate the doctor's understanding are 6 times as likely to be active in decision-making themselves (OR 6.1, CI .76–49.6, p .10). Patient and companion activity in decision-making are not related to one another, indicating that companion activity in decision-making does not promote nor preclude the patient's level of engagement in decision-making. Companions can play important and positive roles in the geriatric primary care visit.
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