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Addressing cancer patient and caregiver role transitions during home hospice nursing care

  • Janella Hudson (a1), Maija Reblin (a1), Margaret F. Clayton (a2) and Lee Ellington (a2)

Abstract

Objective

Many family caregivers and hospice patients experience role changes resulting from advancing illness and the need for increased caregiver responsibility. Successful navigation of conflicts that arise because of these role transitions has been linked to higher quality of patient care and improved caregiver bereavement adjustment. Nursing communication with patients and their caregivers plays an important role in facilitating these transitions. Our objective is to describe patient-caregiver-nurse communication during transitions at end of life.

Method

A secondary, qualitative analysis was conducted on transcripts. Using an iterative process of constant comparison, coders inductively categorized nurse, caregiver, and patient communication behavior into overarching themes. Participants were home hospice nurses and cancer patient/spouse caregiver dyads; participants were >45 years of age, English speaking, and cognitively able to participate. Research took place in the home during nurse visits.

Result

Nineteen unique home hospice visits were analyzed. Patient-caregiver conflict occurred in two major content themes (1) negotiating transitions in patient independence and (2) navigating caregiver/patient emotions (e.g., frustration, sadness). Nurse responses to transition conflict included problem-solving, mediating, or facilitating discussions about conflicts. Nurse responses to emotional conflict included validation and reassurance.

Significance of results

Our findings provide insight into the topics and processes involved in patient and caregiver transitions in home hospice and the role hospice nursing communication plays in mediating potential conflict. Nurses are often asked to take on the role of mediator, often with little conflict resolution communication education; results can be used for nursing education.

Copyright

Corresponding author

Author for correspondence: Maija Reblin, PhD, Moffitt Cancer Center, 12902 Magnolia Dr, MRC – CANCONT, Tampa, FL 33612. E-mail: Maija.reblin@moffitt.org

References

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Bernacki, RE, Block, SD and American College of Physicians High Value Care Task Force (2014) Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine 174(12), 19942003.
Boelk, AZ and Kramer, BJ (2012) Advancing theory of family conflict at the end of life: A hospice case study. Journal of Pain Symptom Management 44(5), 655670.
Bredart, A, Bouleuc, C and Dolbeault, S (2005) Doctor-patient communication and satisfaction with care in oncology. Current Opinion in Oncology, 17(4), 351354.
Cassidy, T (2013) Benefit finding through caring: The cancer caregiver experience. Psychology & Health 28(3), 250266.
Charmaz, K (2006) Constructing grounded theory, London: SAGE.
Checton, MG and Greene, K (2014) “I tell my partner everything … (or not)”. Journal of Family Nursing 20(2), 164184.
Chen, H et al. (2003) Decisions for hospice care in patients with advanced cancer. Journal of the American Geriatrics Society 51(6), 789797.
Chochinov, HM et al. (2015) Eliciting personhood within clinical practice: Effects on patients, families, and health care providers. Journal of Pain and Symptom Management 49(6), 974980.
Clayton, MF et al. (2017) Nursing support of home hospice caregivers on the day of cancer patient death. Oncology Nursing Forum 44(4), 18.
Clayton, MF et al. (2014) Communication behaviors and patient and caregiver emotional concerns: A description of home hospice communication. Oncology Nursing Forum 41(3), 311321.
Corbin, J and Strauss, A (2008) Basics of qualitative research: Techniques and procedures for developing grounded theory. Los Angeles, CA: SAGE.
Duggleby, W et al. (2016) A metasynthesis study of family caregivers’ transition experiences caring for community-dwelling persons with advanced cancer at the end of life. Palliative Medicine 31(7), 602616.
Dy, SM et al. (2015) Measuring what matters: Top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association. Journal of Pain and Symptom Management 49(4), 773781.
Eggly, S et al. (2013) Patient, companion, and oncologist agreement regarding information discussed during triadic oncology clinical interactions. Psychooncology 22(3), 637645.
Ellington, L et al. (2017) Communication among cancer patients, caregivers, and hospice nurses: Content, process and change over time. Patient Education and Counseling 101(3), 414421.
François, K et al. (2017) The nature of conflict in palliative care: A qualitative exploration of the experiences of staff and family members. Patient Education and Counseling 100(8), 14591465.
Fredrickson, BL (2001) The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. American Psychologist 56(3), 218226.
Halperin, E (2013) Emotion, emotion regulation, and conflict resolution. Emotion Review 6(1), 6876.
Hamano, J et al. (2018) Prevalence and predictors of conflict in the families of patients with advanced cancer: A nationwide survey of bereaved family members. Psycho-Oncology 27(1), 302308.
Hopeck, P and Harrison, TR (2017) Reframing, refocusing, referring, reconciling, and reflecting: Exploring conflict resolution strategies in end-of-life situations. Health Communication 32(2), 240246.
Kissane, DW et al. (1994) Psychological morbidity in the families of patients with cancer. Psycho-Oncology 3(1), 4756.
Kramer, BJ et al. (2010) Predictors of family conflict at the end of life: The experience of spouses and adult children of persons with lung cancer. Gerontologist 50(2), 215225.
Laidsaar-Powell, R (2016a) Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences. Patient Education and Counseling 99(7), 11461155.
Laidsaar-Powell, R et al. (2016b) Attitudes and experiences of family involvement in cancer consultations: A qualitative exploration of patient and family member perspectives. Supportive Care in Cancer 24(10), 41314140.
Laidsaar-Powell, R et al. (2017) Oncologists' and oncology nurses' attitudes and practices towards family involvement in cancer consultations. European Journal of Cancer Care 26(1), 114.
Larsen, JT et al. (2017) On the relationship between positive and negative affect: Their correlation and their co-occurrence. Emotion 17(2), 323336.
Manne, S and Badr, H (2008) Intimacy and relationship processes in couples' psychosocial adaptation to cancer. Cancer 112(11 Suppl), 25412555.
Manne, S et al. (2010) Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer. Journal of Cancer Survivorship: Research and Practice 4(1), 7485.
Manne, SL et al. (2007) Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction. Journal of Family Psychology 21(3), 380388.
National Hospice and Palliative Care Organization (2015) NHPCO facts and figures: Hospice care in America. Alexandria, VA: National Hospice and Palliative Care Organization.
Reblin, M et al. (2016) Addressing methodological challenges in large communication data sets: Collecting and coding longitudinal interactions in home hospice cancer care. Health Communication 31(7), 789797.
Reblin, M et al. (2017) Caregiver, patient, and nurse visit communication patterns in cancer home hospice. Psycho-Oncology 26(12), 22852293.
Reblin, M et al. (2015) Social support needs: Discordance between home hospice nurses and former family caregivers. Palliative & Supportive Care 13(3), 465472.
Roter, D and Larson, S (2002) The Roter interaction analysis system (RIAS): Utility and flexibility for analysis of medical interactions. Patient Education and Counseling 46(4), 243251.
Sandelowski, M and Leeman, J (2012) Writing usable qualitative health research findings. Qualitative Health Research 22(10), 14041413.
Scientific Software Development (1999). ATLAS.ti, version 8 (computer software). Berlin, Germany: Scientific Software Development.
Street, RL (2013) How clinician–patient communication contributes to health improvement: Modeling pathways from talk to outcome. Patient Education and Counseling 92(3), 286291.
Street, RL Jr et al. (2009) How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling 74(3), 295301.
Teno, JM et al. (2004) Family perspectives on end-of-life care at the last place of care. Journal of the American Medical Association 291(1), 8893.
Wittenberg, E et al. (2017) Cancer communication and family caregiver quality of life. Behavioral Sciences 7(1), 12.
Wittenberg, E, Goldsmith, J and Neiman, T (2015) Nurse-perceived communication challenges and roles on interprofessional care teams. Journal of Hospice & Palliative Nursing 17(3), 257262.
Zaider, T, Hichenberg, S and Latella, L (2017) Advancing family communication skills in oncology nursing. In Oxford textbook of communication in oncology and palliative care. Kissane, DW, Bultz, BD, Butow, PN et al. (eds.), pp. 181. Oxford University Press.
Zhang, AY, Zyzanski, SJ and Siminoff, LA (2010) Differential patient-caregiver opinions of treatment and care for advanced lung cancer patients. Social Science & Medicine 70(8), 11551158.
Zolnierek, KB and Dimatteo, MR (2009) Physician communication and patient adherence to treatment: A meta-analysis. Medical Care 47(8), 826834.

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