COMMUNICATION

Communication

ABSTRACT

Improvements in modern medicine have changed the trajectory of terminal illnesses. That, along with an already burdened health care system, has resulted in an exponential growth in the number of family caregivers now providing care for their dying loved ones. Family communication is a significant factor in all hospice interactions. Research has shown that families have specific communication patterns that remain consistent through the trajectory of a terminal disease (Syren, Saveman, & Benzein, 2006). Family communication patterns may affect the types of social support available to the family members and the potential for resilience among family caregivers following the death of their loved one. This study used in-depth, qualitative interviews with 15 hospice family caregivers to describe their family communication pattern styles, informal social support, perceptions of their personal resilience and usage of formal social support as provided through hospice services. Data analysis based on a typology of family communication patterns (Wittenberg-Lyles, Goldsmith, Demiris, Parker Oliver, & Stone, 2012, in press) revealed evidence of three distinct patterns of family communication among caregivers in this study. The Partner type, when family communication was open and frequent, was the most prevalent communication pattern described by caregivers. The Manager type, where the family communication was open, but dominated by a single person, was the second most common communication pattern. Only one family caregiver self-identified as the Loner family communication type, where the caregiver has little to no communication with the family and was unsupported in the caregiver burden by other family members. None of the family caregivers identified as Carrier family communication type, which was a low support, low communication family communication pattern.

Only two caregivers used the hospice's bereavement counseling, although several caregivers utilized other hospice support services such as volunteer visitation. When asked about their resilience, caregivers rated themselves anywhere from a moderate resilience to a medium high resilience. Caregivers' resilience perceptions proved to be consistent with their narratives about their caregiving experience.

CHAPTER 1: INTRODUCTION

Improvements in medical science and health care have gradually changed the nature of dying. Death is no longer likely to be the sudden result of infection or injury, but is now more likely to occur slowly, in old age, and at the end of a period of chronic illness. An estimated 65.7 million people in the U.S. have served as unpaid family caregivers to an adult or a child (National Alliance for Caregiving, 2010). In 2009, 31.2% of U.S. households reported that within the last twelve months, at least one person had served as an unpaid family caregiver (National Alliance for Caregiver, in collaboration with AARP, 2009). Research found that widespread reliance on informal caregivers in the U.S. is so great that the cumulative amount of patient services delivered by family members is more than the federal government provided in all possible settings combined (National Alliance for Caregiving and Evercare, 2009).

Informal caregivers deliver support for patients suffering from a variety of conditions, such as advanced age, dementia, cancer or any number of chronic or terminal ...