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The Impact of Family Communication Patterns on Hospice Family Caregivers: A New Typology

Wittenberg-Lyles, Elaine PhD; Goldsmith, Joy PhD; Demiris, George PhD; Oliver, Debra Parker MSW, PhD; Stone, Jacob BA

Journal of Hospice & Palliative Nursing: January/February 2012 - Volume 14 - Issue 1 - p 25–33
doi: 10.1097/NJH.0b013e318233114b
Feature Articles

As patients transition to hospice/palliative care, family members face the challenge of engaging in conversations about prognosis and death. Although conversations about death and dying are optimal during hospice care, few families are able to speak openly and candidly about disease and illness and little is known about the impact of family communication patterns on the primary caregiver’s stress and ability to cope. Family Communication Patterns Theory was used as a framework to investigate caregiver concerns related to family roles and responsibilities during hospice care. Audio-recorded discussions were reviewed for caregiver concerns involving 1 or more family members, and thematic coding was used to analyze the data. This study empirically identified 4 types of hospice family caregivers (manager, carrier, partner, and loner) through family communication patterns. With the exception of partner caregiver types, family caregivers deferred to the hierarchical role within the family (conformity) over communication (conversation) during hospice. Conformity in family communication did not equate with family agreement or open communication. Families emphasized communication patterns in line with family hierarchical roles rather than engaging in conversation and disclosure. Caregiver typologies can guide clinicians in using more sculpted and appropriate communication skills and practices to enable care and inclusion of family caregivers.

Elaine Wittenberg-Lyles, PhD, is Associate Professor, Markey Cancer Center, Department of Communication, University of Kentucky, Lexington.

Joy Goldsmith, PhD, is Associate Professor, Department of Communication Studies, Young Harris College, Georgia.

George Demiris, PhD, is Associate Professor, Biobehavioral Nursing and Health Systems, School of Nursing and Biomedical and Health Informatics, School of Medicine, University of Washington, Seattle.

Debra Parker Oliver, MSW, PhD, is Associate Professor, Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, Columbia.

Jacob Stone, BA, is Master’s Degree Student, Department of Environmental Science, Miami University, Oxford, Ohio.

Address correspondence to Elaine Wittenberg-Lyles, PhD, Markey Cancer Center, University of Kentucky, 741 S Limestone, B357 BBRSB, Lexington, KY 40506-0509 (

The authors have no conflict of interest to disclose.

This project was funded by the NIH National Institute of Nursing Research Grant No. R21 NR010744-01 (A Technology Enhanced Nursing Intervention for Hospice Caregivers, Dr Demiris, principal investigator).

© 2012 The Hospice and Palliative Nurses Association