Family caregiver communication in oncology: advancing a typology.

OBJECTIVES: The quality of communication between the patient and family caregiver impacts quality of life and well-being for the two; however, providers have few tools to understand communication patterns and assess the communication needs and preferences of caregivers. The aims of this study were to examine family communication patterns among oncology patients and their caregivers and to identify common characteristics among four different types of family caregivers. METHODS: Nurses recruited oncology patient-caregiver dyads through a large cancer treatment center in the Southeast. Patients and caregivers were separated from one another and interviewed during chemotherapeutic infusions. Interviews were recorded, transcribed, coded, and thematized. RESULTS: A sample of 24 patients and their caregivers (n = 48) were interviewed. The majority of dyads (21, 88%) shared the same family communication pattern. Common caregiver communication features support previous work identifying four caregiver communication types: Manager, Carrier, Partner, and Lone caregivers. Manager caregivers lead patients by utilizing extensive medical knowledge, whereas Carrier caregivers were led by patients and described tireless acts to maintain the family and avoid difficult conversations. Partner caregivers facilitated family involvement and open communication on a variety of topics, while Lone caregivers focused solely on biomedical matters and a hope for cure. CONCLUSIONS: Caregiver communication types were corroborated by patient-caregiver descriptions of caregiving. However, more information is needed to ascertain the variables associated with each caregiver type. Future work to improve identification of caregiver types and create targeted caregiver care plans will require further study of health literacy levels and tested communication interventions per type.

Enhancing Communication Related to Symptom Management Through Plain Language.

CONTEXT: Symptom management is a key dimension of palliative care. In addition to aspects such as assessment and pharmacological management of symptoms, professionals also require communication skills to effectively manage symptoms in serious illness. OBJECTIVES: Application of the Plain Language Planner for Palliative Care(©), a provider tool for communicating about medication and symptoms using plain language, was tested. METHODS: Approximately 75% of the 155 health care professionals, mostly nurses, who participated in a before-and-after educational activity about the tool, provided written communication explanations using one of three medication-symptom pairs: senna for constipation, amitriptyline for nerve pain, and lorazepam for anxiety. Responses were coded for plain language characteristics: active voice, second person, use of jargon, brief sentences, reading level, and easy to understand data phrasing. Frequency counts for coding categories were calculated and compared across medication-symptom pairs before and after the education session. RESULTS: A comparison between written responses before and after the education session showed improvement in the use of plain language. Overall, plain language scores were highest for communication about senna (81%), followed by amitriptyline (72%) and lorazepam (77%). Across all three medication-symptom pairs, the greatest improvement in the use of plain language occurred in the use of jargon. CONCLUSION: Provider training with the tool produced increased plain language. Use of the tool in provider education shows promise in increasing the health literacy for patients and families regarding symptom management.

The entry-level physical therapist: a case for COMFORT communication training.

Entry-level physical therapists provide clinical care for patients with functional mobility limitations. Their care spans the continuum of settings, disease processes, and diagnoses. Although effective communication skills are required to conduct physical therapy work, there is limited instruction provided in physical therapy education and students receive little exposure to seriously or chronically ill patients. The goal of this study was to assess the effects of communication training for the entry-level physical therapist facing palliative and end-of-life communication with patients/families. A pre-post survey design and narrative writing were used to assess the effect of the COMFORT communication training curriculum provided to doctorally trained, graduating physical therapists. The study demonstrated decreased student apprehension about communicating with dying patients and their families, and a comparison of mean scores reflecting the students' communication knowledge, confidence, and behaviors increased in a positive direction. As students became more willing to communicate, they were also more adept at integrating task and relational messages, as well as assimilating emotional support messages for patients and families. This study shows promise for the feasibility and utilization of the COMFORT curriculum for entry-level physical therapists. Further research should address the integration of COMFORT earlier into physical therapy education, as well as assess evidence of COMFORT communication skills in the clinical context.

Palliative care communication.

OBJECTIVES: To summarize the challenges of teaching, practicing, and learning palliative care communication and offer resources for improving skills and educating others. DATA SOURCES: A theoretically grounded, evidence-based communication curriculum called COMFORT (Communication, Orientation and opportunity, Mindful presence, Family, Openings, Relating, and Team). CONCLUSION: The COMFORT curriculum is available for free through a Web site, a smartphone/iPad application, and online for continuing education units. IMPLICATIONS FOR NURSING PRACTICE: The COMFORT curriculum provides resources to support the expansion and inclusion of palliative care practice not only in oncology, but also in a wide variety of disease contexts.