Importance of Family-Centred Care to Palliative Medicine

Abstract

The family is inevitably involved in care-provision when one of its number suffers from a progressive and life-threatening illness such as advanced cancer. Distress reverberates throughout the family, with moderate rates of psycho-social morbidity, including up to one third ofpartners and one quarter of adult children (1-3). There has been growing awareness over recent years of the importance of a family-centred model of care to fully meet the needs of patients and families involved with palliative care services and, moreover, maintain continuity of support into bereavement (4). To achieve this, we need both conceptual and pragmatic methods of classifying families to guide our efforts at intervention. Historically, one approach has been to conceptualize families in terms of the phase of illness they must negotiate (5); another stressed the family's needs or the associated burdens it experienced (6); a third focused on the family's developmental stage (7). Yet none of these approaches proved predictive of psycho-social outcome over time. It was not until attention turned to family functioning that a clinically useful method of predicting psychosocial outcome emerged (8,9). Through these longitudinal studies of families during palliative care and bereavement, we were able to classify families using the following dimensions of their functioning: (i) cohesiveness, the family's sense of togetherness; (ii) expressiveness, their sharing of both thoughts and feelings; and (iii) conflict resolution. These dimensions form a simple screening instrument, the 12 item Family Relationships Index (10).