Cancer‐Related Communication During Sessions of Family Therapy at the End of Life
TL;DR: The extent of cancer‐specific communication during family sessions at the end of life and characteristics associated with SC are described and the association between SC and longer‐term family bereavement outcomes is determined.
Abstract: Objectives A goal of family-focused therapies in oncology is to help families communicate effectively about illness and its management. Yet there has been no examination of whether and how conjoint sessions are conducive to this process. In this study, we (a) described the extent of cancer-specific communication during family sessions at the end of life; (b) identified characteristics associated with SC; and (c) determined the association between SC and longer-term family bereavement outcomes. Methods Data were collected as part of a randomized controlled trial of Family Focused Grief Therapy (FFGT) for advanced cancer patients and their families. Demographics, depressive symptoms, and family functioning were assessed at baseline. Cancer-specific communication, perceived responsiveness to communication, and therapeutic alliances were reported after each session. At 13-month bereavement, surviving families were assessed for symptoms of depression and prolonged grief disorder (PGD). Results Participants were 257 advanced cancer patients and family members receiving FFGT at the end of life. On average, participants perceived significantly more cancer-related communication in session (SC) than at baseline. Both therapist-family and within-family alliances were associated with SC, especially for those with more severe depressive symptoms at baseline. Long-term outcomes were moderated by perceived responsiveness to in-session communication: for those who perceived high responsiveness, SC was associated with fewer depressive and PGD symptoms in bereavement. Conclusions Conjoint family sessions can effectively increase communication about cancer at the end of life. Clinicians should consider key contextual factors in their effort to facilitate this process: perceived responsiveness, family role, alliances with therapist, and within-family.
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TL;DR: This study validates the combined effect of family systems, school systems, and personal systems on problem behaviors and has certain guiding significance for the prevention and intervention of problem behaviors among adolescents.
Abstract: Problem behaviors have always been a hot topic in the field of adolescent research. It is particularly important to study how problem behaviors are developed. Empirical evidence examining problem behaviors has shared the premise that perceived school climate and family functioning play a role in the development of problem behaviors in adolescents. However, it is less clear whether the interaction of perceived school climate and family functioning can predict problem behaviors in adolescents and which mechanisms within the process it might affect. The present study developed a moderated mediation model to investigate the relationship between perceived school climate, family functioning, psychological suzhi, and problem behaviors in early adolescents. Participants were 1,072 Chinese junior high school students who completed the Perceived School Climate Questionnaire, the Strengths and Difficulties Questionnaire, the Psychological Suzhi Questionnaire for Middle School Students, and the Family APGAR scales. Data were analyzed using IBM SPSS Statistics version 22.0, including descriptive statistics and correlation analysis. The mediating effect and moderating effect were tested by SPSS PROCESS. Results showed that there was a significant negative correlation between perceived school climate and problem behaviors and a partial mediating role of psychological suzhi between perceived school climate and problem behaviors. Moreover, the influence of perceived school climate on psychological suzhi was moderated by family functioning. Indirect effects were significant in participants with high versus low family functioning. There was an interaction between family and school, and psychological suzhi played an important role between environment and adolescent behaviors. This study validates the combined effect of family systems, school systems, and personal systems on problem behaviors and has certain guiding significance for the prevention and intervention of problem behaviors among adolescents.
19 citations
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TL;DR: The quality of naturalistic communication between patients with advanced cancer and their spouse caregivers is described using observational methods and the association between patient and caregiver communication behaviors and psychological and physical health is assessed using the actor‐partner interdependence model.
Abstract: Objective The goal of this study was to describe the quality of naturalistic communication between patients with advanced cancer and their spouse caregivers using observational methods. We also assessed the association between patient and caregiver communication behaviors and psychological and physical health using the actor-partner interdependence model. Methods Data on 81 dyads were gathered as part of a prospective observational study. Patients with advanced cancer and their spouse caregivers completed demographic, physical health, and emotional well-being questionnaires. Cancer and relationship communication captured in "day-in-the-life" audio recordings were coded using Gottman's Turning System to assess the quality of bids for attention and responses. Results Bids for attention were most often informational (Low Bids) and responses were mostly positive and effortful (Turn Towards); patients and caregivers did not significantly differ in communication behavior. More effortful bids for attention (High Bids) were associated with more positive and effortful responses. Patient communication behaviors were significantly associated with caregiver emotional well-being, whereas caregiver communication behaviors were significantly associated with their own emotional well-being and patient physical health. Conclusions While patients may benefit from caregivers' more positive and engaged communication at home, the emotional labor of focusing on and engaging the patient may take a toll on caregivers' own well-being. This work contributes to the understanding of what everyday communication looks like for patients with advanced cancer and their spouse caregivers and how this communication may impact physical and psychological health. Our findings provide a foundation to develop guidelines for psychosocial couple-based interventions.
9 citations
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TL;DR: The family functioning associated with CG and MDD developing either independently or co‐morbidly in the bereaved families of patients with advanced cancer who died in palliative care units (PCUs) is explored.
Abstract: Objectives Family conflict and family functioning were regarded as changeable factors associated with complicated grief (CG) and major depressive disorder (MDD) in the bereaved families of patients with advanced cancer, although the evidence is limited. We explored the family functioning associated with CG and MDD developing either independently or co-morbidly in the bereaved families of patients with advanced cancer who died in palliative care units (PCUs). Methods This study comprised a nationwide cross-sectional questionnaire survey of bereaved family members of cancer patients who died in Japanese PCUs participating in evaluation of the quality of end-of-life care. Results A total of 529 questionnaires (69.2%) were returned, and we analyzed a total of 458 responses. A total of 14.2% of participants were considered as having CG, 22.5% as having moderate to severe depression, and 9.6% as having co-morbid symptoms. Multivariate logistic regression analysis revealed that many family members insulted or yelled at one another (odd ratio [OR]: 2.99, p = 0.046; OR:2.57, p = 0.033), and conflict regarding what is meant by a good death (OR:3.60, p = 0.026; OR:4.06, p = 0.004) was significantly positively associated with CG, MDD, and co-morbid symptom. Conclusions Specific family conflicts may increase the incidence of CG, MDD, and co-morbid symptoms in the bereaved families of patients with advanced cancer. Our results may encourage health care providers to approach discussions about end-of-life issue with the patient and their family in advance, especially focusing on what is considered a good death for the patient, which may prevent or resolve the family conflict.
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TL;DR: In this article , the effect of social isolation of minors living with a parent or grandparent suffering from ALS and the psychological support offered by an Italian no-profit association helped them to manage stress.
Abstract: Purpose: The purpose of this study is to assess the effect of social isolation of minors with a parent or grandparent suffering from amyotrophic lateral sclerosis (ALS) and to determine whether the psychological support offered by an Italian no-profit association helped them to manage stress.Methodology: This study followed a qualitative research design. The participants responded to in-depth interviews that were processed with inductive thematic analysis.Findings: Five themes emerged: feedback on the psychological intervention; learning and changes after the intervention; discourses on illness and death in the family; experiences and difficulties during the lockdown and suggestions for other peers who might face the same situation.Social Implications: Psychological support is necessary for these minors, and it helped them to manage both the stress of living with ALS and the limitations of social relationships during the pandemic. It showed the importance of authentic and honest communication about illness and death that allowed minors to manage anxiety and fear. Positive reinterpretation of these experiences by transforming them into opportunities was also revealed.Originality: Studies on families with ALS patients are numerous, but studies on children of these patients are still rare, and no study has investigated the impact of the COVID-19 pandemic on these children. This research investigated a topic that has not been covered previously and it also provided the opportunity to know how these children, preadolescents and adolescents living in an already complex environment, have experienced lockdown and restrictions. The study also enriched the literature on this important issue.
2 citations
References
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TL;DR: The Inventory of Complicated Grief, a scale with demonstrated internal consistency, and convergent and criterion validity, provides an easily administered assessment for symptoms of complicated grief.
Abstract: Certain symptoms of grief have been shown (a) to be distinct from bereavement-related depression and anxiety, and (b) to predict long-term functional impairments. We termed these symptoms of "complicated grief" and developed the Inventory of Complicated Grief (ICG) to assess them. Data were derived from 97 conjugally bereaved elders who completed the ICG, along with other self-report scales measuring grief, depression, and background characteristics. Exploratory factor analyses indicated that the ICG measured a single underlying construct of complicated grief. High internal consistency and test-retest reliabilities were evidence of the ICG's reliability. The ICG total score's association with severity of depressive symptoms and a general measure of grief suggested a valid, yet distinct, assessment of emotional distress. Respondents with ICG scores > 25 were significantly more impaired in social, general, mental, and physical health functioning and in bodily pain than those with ICG scores < or = 25. Thus, the ICG, a scale with demonstrated internal consistency, and convergent and criterion validity, provides an easily administered assessment for symptoms of complicated grief.
1,279 citations
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TL;DR: Overall, the findings strongly supported the conceptualization of intimacy as a combination of self-disclosure and partner disclosure at the level of individual interactions with partner responsiveness as a partial mediator in this process.
Abstract: H. T. Reis and P. Shaver's (1988) interpersonal process model of intimacy suggests that both self-disclosure and partner responsiveness contribute to the experience of intimacy in interactions. Two studies tested this model using an event-contingent diary methodology in which participants provided information immediately after their social interactions over 1 (Study 1) or 2 (Study 2) weeks. For each interaction, participants reported on their self-disclosures, partner disclosures, perceived partner responsiveness, and degree of intimacy experienced in the interaction. Overall, the findings strongly supported the conceptualization of intimacy as a combination of self-disclosure and partner disclosure at the level of individual interactions with partner responsiveness as a partial mediator in this process. Additionally, in Study 2, self-disclosure of emotion emerged as a more important predictor of intimacy than did self-disclosure of facts and information.
1,059 citations
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TL;DR: In this article, the authors investigated the characteristics of observations which cause them to be influential in least square analysis and related to residual variances, residual correlations, and the convex hull of the observed values of the independent variables.
Abstract: Characteristics of observations which cause them to be influential in a least squares analysis are investigated and related to residual variances, residual correlations, and the convex hull of the observed values of the independent variables. It is shown how deleting an observation can substantially alter an analysis by changing the partial F-tests, the studentized residuals, the residual variances, the convex hull of the independent variables, and the estimated parameter vector. Outliers are discussed briefly, and an example is presented.
745 citations
"Cancer‐Related Communication During..." refers methods in this paper
...Model diagnostics, including Cook's d and Cluster Cook's d, were used to identify influential points for casewise deletion.(34) GEE regression models were used to examine the effect of pretherapy variables (ie, family role, family functioning, and depressive symptoms) on communication, and their interaction with alliance scores in predicting communication....
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01 Jan 1994
606 citations