Part of Symposium - Optimizing family's adjustment during the transition from palliative care to bereavement (by Youngmee Kim)
Purpose: Many recognize the benefit of supporting the family as a caregiving system in the setting of advanced cancer (Zaider and Kissane, 2009). A common objective is to facilitate communication about cancer-related concerns and thus achieve a shared understanding of illness and unmet needs. Although communication is recognized to play a vital role in the quality of end-of-life experiences (King and Quill, 2006), there has been little specification of what clinicians need to do during their encounters with families in order to facilitate this process. Family Focused Grief Therapy (FFGT) is an empirically supported model of family support, whereby distressed families are offered a series of family meetings beginning in palliative care through bereavement. In this study, we examined specific clinician behaviors during sessions of FFGT that were associated with increased communication across sessions.
Method: This study was done within a larger ongoing NIH-funded randomized controlled trial of FFGT. 58 palliative care families (196 individuals) receiving FFGT completed questionnaires following each family session: (2) the Family Session Disclosure Measure (FSDM) a measure of perceived in-session family communication (adapted from Manne et al., 2004a); (2) the Family Therapy Alliance scale (Pinsof, et al., 2008), which inquires about family cohesiveness and alliance with therapist. The presence/absence of in-session clinician behaviors (i.e., structuring, engagement, relational orientation) were coded by independent raters using the Treatment Integrity Scale.
Results: Using the family cluster as the unit of analysis, linear mixed-effects models were specified, with a fixed session effect to represent the overall profile of disclosure change over time. Results indicated that in-session cancer-related disclosure increased by an average of 1.26 points per session (t=7.07, p<0.05). Active engagement/joining with the family, and maintaining a relational orientation were behaviors significantly associated with family members’ benefit from sessions.
Conclusion: A clinician’s capacity to promote consensus and joining within the family, engage family members collaboratively and maintain a systemic and relational focus may be important ingredients to promoting improved family members’ well being.