FCOF

In a few minutes we'll have you observe some video clips of doctors interacting with patients and family members during medical visits. You'll be asked to provide feedback to these doctors using the Family Centered Observation Form (FCOF), so let's first orient you to the FCOF and show you a few of its unique features.

The Family-Centered Observation Form has 6 categories:

Establishing Rapport with Patient and Family Members
Family-Centered Agenda Setting
Family-Centered Interviewing - SKILLS
Family-Centered Interviewing - PROCESS
Family-Centered Interviewing - CONTENT
Family-Centered Care Planning

Each category contains 5-12 specific skills (observable behaviors) which are defined in the literature as key elements of patient-centered and family-centered care. The FCOF (paper version) might look something like this when it is filled out:

You'll notice that space is provided in each category for you to add comments. Although a checkbox can prompt an observer to look for certain skills, a checkmark could never provide the richness of feedback that personalized comments can offer. Hence we use both checkboxes and comments in the FCOF.

Note: A skill left unchecked does not mean the care provider does not have that particular skill; rather, it just means you did not observe it. Check only what you see or hear. Don't give the benefit of the doubt.

Some items may not be applicable to every visit. In the example above, the doctor did not have a medical student or anyone else with her in the room, therefore the observer just crossed out the not applicable item:

Patient-Centered Versus Family-Centered

A healthcare provider may offer Patient-Centered care without necessarily being Family-Centered; however, we believe it is not possible to provide quality Family-Centered care without being Patient-Centered. The one is built upon the other. For this reason the FCOF differentiates between critical skills and fundamental skills. Circle check boxes are used to indicate critical (family-centered) skills, whereas square boxes are used to indicate fundamental (patient-centered) skills:

Notice that critical skills are required for both competency and proficiency. What is the difference between a "Competent" and "Proficient" designation? Both are good and should be celebrated when achieved, but one is higher than the other inasmuch as not all medical visits offer the complexity required to demonstrate proficiency. Here's an analogy to help explain:

If we watch a skier going down an average difficulty ski run and see that he has no problems with it, we conclude that he is a competent skier. His skills are good enough to meet the demands of that ski run. He is no novice, but is he a proficient skier? Only when we watch him ski down an expert-level ski run are we able to determine if his skills are truly proficient.

The lack of complexity in some medical visits simply doesn't allow care providers to demonstrate (and observers to observe) a proficient level of family interviewing skills. For example, a simple visit for an acute respiratory illness with only one patient in the room is a much easier "ski run" than a visit for a patient with multiple chronic medical and psychosocial problems and three family members present, each with differing opinions on the patient's diagnoses and treatments.

Please note, a care provider receiving a novice designation may actually have wonderful patient-centered skills. In the FCOF we are looking for family-centered skills. He or she may be very patient-centered, but a novice when it comes to interviewing in a family-oriented manner. You can read more about skills for patient-centered communication in this article (1). For specific training in patient-centered communication skills, including the Patient-Centered Observation Form (PCOF), click here.

One last thing before we move on. We use the term "family" recognizing that families are very diverse with many different constitutions. In the broadest sense, a patient's family includes anyone close to the patient who has direct influence on his or her health behaviors and outcomes. The FCOF was built with this broadest definition in mind.

References

Hashim, M. J. (2017). Patient-Centered Communication: Basic Skills. American family physician, 95(1).