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.
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.
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. 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.
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