Managing conflict during home hospice nursing visits: Communication between nurses, cancer patients, and spouse caregivers.

Abstract

39 Background: Many hospice cancer patients and their spouse caregivers experience conflict as roles change and patients decline. Nurses can be asked to mediate conflicts during home visits. Our objective is to describe patient-caregiver conflict and nurse responses in home hospice communication. Methods: A secondary, qualitative analysis was conducted on transcripts of nurse visits to home hospice cancer patients and their spouse caregivers. Transcripts were selected based on high caregiver and patient emotion, identified by interaction analysis coding in primary analysis. Using an iterative process of constant comparison, coders inductively categorized nurse and dyad communication behavior during conflict into overarching themes. Results: 19 visits were identified for analysis. Nurses (from 7 hospice agencies) were all female and averaged 13 years nursing experience (SD = 11). Patient-caregiver dyads were all white, heterosexual, married an average 36 years (SD = 20). 84% of patients were male and average age was 72 years (SD = 9). Caregiver average age was 68 years (SD = 11). Patient-caregiver conflict fell under two major content themes 1) negotiating transitions in patient level of independence and 2) navigating patient/caregiver emotions (e.g. frustration, sadness). When not explicitly asked for input during conflict, nurses occasionally did not engage. Nurse response to transition conflict included problem-solving, mediating, or facilitating dyadic discussion about conflicts/concerns raised with her independently. Nurse response to emotional conflict included validation and reassurance. Conclusions: Little research has been conducted on couples’ conflict resolution in cancer home hospice. However, unresolved conflict can impact the quality of care and has been linked to poor bereavement adjustment. Nurses are sometimes asked to take on the role of mediator, often with little training. Our findings provide insight into home hospice patient and caregiver conflict communication with hospice nurses and could be used during nursing education. Further research could address specific patient and caregiver outcomes associated with nurse communication strategies.