Effective TB Interviewing for Contact Investigation: Self-Study Modules
A proxy is a person who is interviewed in the place of the index patient. Proxies are used based on local standards of practice when the index patient is unable to be interviewed. For example, a proxy could be used if the patient is
- Physically or mentally unable to adequately communicate or provide information
- A child
- Unable to be located
A proxy should not be engaged simply because the patient is unwilling to be interviewed. This is also true for a patient who does not speak the same language as the interviewer. In this case, instead of using a proxy, an interpreter should be used.
Prior to the interview, the interviewer will decide whether to use a proxy or not. Whenever it is not possible to interview the index patient due to death or medical or mental condition, the interviewer should interview one or more persons who are likely to know the patient’s practices, habits, and behaviors and are able to identify persons with whom the patient has been in contact. Any notes in the medical record from a social worker can also be helpful. Obviously, in the case of a deceased or very young patient, the need to use a proxy is very clear. If the interviewer decides to interview the actual patient, a decision to introduce a proxy can be made at any time during the interview.
A proxy can be a family member or close friend, and should be who knows the patient and his or her routine well. Family members who visit the patient in the hospital or at home regularly or are designated as next of kin or emergency contacts are the best choice. In a congregate setting, the proxy may not have clear personal knowledge of the patient, but may have access to documentation in the form of schedules or records, which provide data on the patient’s exposure setting(s). For example, in a correctional setting, if an index patient has been released and cannot be located, a worker within the setting may be able to provide information on the patient’s contacts based on records of the inmate’s locations during incarceration and his or her documented routine. There may be more than one proxy used for an interview. However, this should only be done if additional useful information can be derived from interviewing others.
Though a proxy is not the index patient, confidentiality is just as important. The interviewer should educate the proxy about the health department’s policy of protection of confidentiality. The proxy should also be informed about his or her responsibility in keeping information about the index patient confidential. Even though in most states information about deceased patients need not remain confidential, respect and sensitivity are required, especially if the proxy is a family member or close friend of the index patient.