Physicians Interacting With Family Caregivers
Responding to Difficult Situations
Family caregivers may believe that their concerns are inevitable and their needs cannot be met. In an ideal setting, the social worker or psychologist should be present at meetings with family caregivers to assist with follow-up and support.
Just as a patient's family can appoint a spokesperson, the oncology team can designate a family liaison. However, most family caregivers prefer direct access to the treating oncologist; in fact, active listening by physicians may reduce caregiver burden. One study found that caregivers experienced less burden and distress if they felt that the treating physician listened to their needs and opinions. The oncology team should maintain frequent communication to ensure that messages and other information delivered to the family are consistent and that treatment goals are clear to all concerned.
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. 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. 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). 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.