Nursing Support of Home Hospice Caregivers on the Day of Patient Death

Abstract

Purpose In this study we add to a sparse literature describing nurse-caregiver communication on the day of cancer patient death. Design A descriptive secondary analysis of 44 audiotaped home-hospice, day of death, nursing visits. Setting Nine hospices across three states. Sample 42 caregiver-cancer patient dyads; 27 hospice nurses. Methods Audiorecordings were coded for supportive nursing communication and relative time spent in physical, psychosocial and spiritual discussion. Variables Tangible, emotional, informational, esteem and networking supportive communication; Caregiver religious affiliation. Findings Nurses reported their communication skills were less effective when discussing difficult topics as compared to their overall communication effectiveness. Eleven patients died before the nursing visit, three died during the visit, 30 died post-visit. Nurses primarily engaged in discussions facilitating caregiver emotional, tangible, and informational support. More informational support was observed when patient death occurred during the nursing visit. Time spent in general conversational categories showed that physical care conversations predominated (80% of the average overall amount of conversation time), lifestyle/psychosocial discussions 14%, spiritual discussions 6%. Spiritual discussions were observed in only 7 of 44 hospice visits. Spiritual discussions, although short and infrequent, were significantly longer on average for caregivers without a religious affiliation. Conclusions Nurses support caregivers on the day of cancer patient death using multiple supportive communication strategies. Spiritual discussions are minimal. Nursing Implications Communication skills programs can potentially increase self-reported communication effectiveness. Emerging acute spiritual concerns, especially for caregivers without a previous religious affiliation, should be anticipated. Spiritual support is included in the hospice model of holistic care.

Communication among cancer patients, caregivers, and hospice nurses: Content, process and change over time

“…With a growing number of terminal cancer patients wanting to spend their final days at home, and the critical nature of communication for patient and caregiver outcomes, it is essential to better understand current practice. In addition, nursing support and relationships during critical events across care domains are likely to be remembered by the caregiver and family for years, and woven into the story as part of how caregivers relay the death of the patient to others in the future[12].…”

“…To examine the unique nature of communication in home hospice cancer care and potentially identify areas for improved communication, we conducted a multi-site observational longitudinal study. Multiple stakeholders participated: the patient, who gradually relinquishes autonomy as death approaches [12]; the family caregiver, who provides increasingly complex care while managing their own stress and impending loss [12]; and the hospice nurse, who oversees and coordinates patient and caregiver interdisciplinary care [13]. As necessitated by the relatively short periods of hospice care in the U.S. for cancer patients (i.e.…”

“…[15] As patients decline, caregivers assume more tasks for which they are often unprepared while simultaneously managing feelings of loss and grief [16] [6]. The hospice nurse has the opportunity to both support as well as educate patients and caregivers as death approaches, requiring strong communication skills across domains of care[12].…”

Positive emotion communication: Fostering well-being at end of life

“…Previous research has mainly focused on how to identify and reduce caregiver and patient distress. Specifically, health communication research has focused on improving provider communication skills to address and alleviate caregiver and patient negative emotion expression [34, 67]. Equally important is building communication skills to scaffold and build a sense of strength, connection, and joy despite facing loss and life-limiting illness.…”

Caregiver, patient, and nurse visit communication patterns in cancer home hospice

“…There is extensive research on physician‐patient communication in clinical settings, even at the end of life . While clinic‐based interactions often represent important conversations such as breaking bad news or treatment decisions, they may neglect other key milestones in a care trajectory, such as managing active decline and day of death . Moreover, few studies have focused on the triadic communication processes of provider, patient, and caregiver in health care; those few studies have largely focused on a clinical consultation setting .…”