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Physicians Interacting With Family Caregivers

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Responding to Family Conflict

Some families may have less-than-optimal internal relationships, which may lead to communication difficulties within the family and with health care professionals. Many families are not happy, tight-knit units, and the stress of caring for a relative with cancer can reignite unresolved conflicts or create new conflicts.[9] It may be beyond the scope of the oncology team to resolve long-standing family conflict. Use of the family meeting and one family-appointed spokesperson as a communication liaison with the oncology team can help to ameliorate some of these difficulties.

Appointing a Family Spokesperson

Oncology clinicians can be frustrated by having to provide the same information to family caregivers repeatedly. A caregiver's ability to absorb and retain information may be compromised by depression, fear, anxiety, and sleep deprivation.[10] It is advisable for clinicians to request that the family appoint a spokesperson through whom information can be delivered. In addition, the oncology team should try to promote an environment that is conducive to information exchange (i.e., a quiet, private place with minimal interruptions).[11] To ensure that caregivers have heard and understood the information, they should be prompted to ask questions and should be provided with written backup notes, user-friendly articles, or a list of Web sites for later reference.

Convening a Family Meeting

The family meeting is a valuable clinical tool for communicating medical information, delineating the goals of care, and facilitating decision making in cancer treatment. Outcome studies validating the effectiveness of the family meeting are beginning to emerge, especially from the intensive care unit literature. The family meeting is an ideal forum for:

  • Eliciting caregiver concerns.
  • Providing clear information about treatment.
  • Facilitating end-of-life care decisions.
  • Deciding to avoid inappropriate treatment options.

In addition, caregivers can receive reassurance that symptoms will be adequately managed and patient preferences will be respected.[12]

Successful family meetings promote a safe setting in which caregivers can process emotions and have their concerns validated. Family meetings are most effective when:[11,13]

  • The agenda is transparent to patients, families, and professional staff.
  • There is a clearly designated staff person in the role of leader.
  • Family caregivers are given the opportunity to ask questions, express concerns, and confront painful emotions with the help of trained and compassionate professionals.

(Refer to the PDQ summary on Communication in Cancer Care for more information about communication among clinicians, patients, and families.)

Dealing With Psychological Issues

Patients facing the end of life face enormous physical and existential challenges. Enhanced understanding of the common psychological concerns of patients with serious illness and their caregivers can improve not only clinical care but also the physician's sense of satisfaction and meaning in caring for the dying patient.[14] Physicians also must be attentive to their own needs, which may include feelings of grief and loss, compassion fatigue, and a sense of detachment. In addition to caring for the patient and family, oncologists are advised to pursue healthy venues that promote adaptive coping.[15]

References:

  1. Hudson PL, Aranda S, Kristjanson LJ: Meeting the supportive needs of family caregivers in palliative care: challenges for health professionals. J Palliat Med 7 (1): 19-25, 2004.
  2. Ngo-Metzger Q, McCarthy EP, Burns RB, et al.: Older Asian Americans and Pacific Islanders dying of cancer use hospice less frequently than older white patients. Am J Med 115 (1): 47-53, 2003.
  3. Pinquart M, Sörensen S: Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: a meta-analysis. Gerontologist 45 (1): 90-106, 2005.
  4. Huang HL, Chiu TY, Lee LT, et al.: Family experience with difficult decisions in end-of-life care. Psychooncology 21 (7): 785-91, 2012.
  5. Arnold RL, Egan K: Breaking the "bad" news to patients and families: preparing to have the conversation about end-of-life and hospice care. Am J Geriatr Cardiol 13 (6): 307-12, 2004 Nov-Dec.
  6. Back AL, Arnold RM, Baile WF, et al.: Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med 167 (5): 453-60, 2007.
  7. Back AL, Arnold RM, Baile WF, et al.: Approaching difficult communication tasks in oncology. CA Cancer J Clin 55 (3): 164-77, 2005 May-Jun.
  8. Emanuel EJ, Fairclough DL, Slutsman J, et al.: Assistance from family members, friends, paid care givers, and volunteers in the care of terminally ill patients. N Engl J Med 341 (13): 956-63, 1999.
  9. Harris KA: The informational needs of patients with cancer and their families. Cancer Pract 6 (1): 39-46, 1998 Jan-Feb.
  10. Radwany S, Albanese T, Clough L, et al.: End-of-life decision making and emotional burden: placing family meetings in context. Am J Hosp Palliat Care 26 (5): 376-83, 2009 Oct-Nov.
  11. Gueguen JA, Bylund CL, Brown RF, et al.: Conducting family meetings in palliative care: themes, techniques, and preliminary evaluation of a communication skills module. Palliat Support Care 7 (2): 171-9, 2009.
  12. Boyle DK, Miller PA, Forbes-Thompson SA: Communication and end-of-life care in the intensive care unit: patient, family, and clinician outcomes. Crit Care Nurs Q 28 (4): 302-16, 2005 Oct-Dec.
  13. Azoulay E: The end-of-life family conference: communication empowers. Am J Respir Crit Care Med 171 (8): 803-4, 2005.
  14. Block SD: Perspectives on care at the close of life. Psychological considerations, growth, and transcendence at the end of life: the art of the possible. JAMA 285 (22): 2898-905, 2001.
  15. Kutner JS, Kilbourn KM: Bereavement: addressing challenges faced by advanced cancer patients, their caregivers, and their physicians. Prim Care 36 (4): 825-44, 2009.

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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