Family participation in geriatric decision-making: Marginalization of older patients’ autonomy in Chinese outpatient consultation

Family participation is regarded as crucial for promoting patient well-being, particularly in geriatric care, where patients often face greater challenges and require additional support in making medical decisions. The importance of family participation is frequently framed within a cultural context that acknowledges differing conceptions of autonomy. However, it remains unclear how family members are actually prompted or discouraged in their participation in medical decision-making. This article aims to identify the interactional patterns of decision-making during accompanied geriatric consultations and to examine the underlying mechanisms shaping these dynamics. Focusing on audio recordings of 86 geriatric encounters, the mixed-method study identified four decision-making patterns through nuanced Conversation Analysis: direct family surrogation, substitute family surrogation, and patient-centered collaboration. A subsequent quantitative analysis was conducted to explore factors influencing these decision-making patterns, in which the identity of the companion emerged as a key factor shaping interactional dynamics, with adult children being significantly more likely to assume a surrogate role than spouses. These findings are discussed in the context of the broader social structure of elder care and the institutional constraints present in the Chinese medical system. This study emphasizes the need for caution in overemphasizing cultural characteristics, as doing so risks systematically marginalizing the social agency and self-efficacy of older adults. We call for greater efforts to ensure the meaningful participation of older individuals in healthcare decisions.