When we think of the importance of evidence-based findings to guide our practice, it is important to not only refer to data within our immediate field of practice, but also to keep abreast of collateral research. Thus was my recent revelation in reading an excellent article by experts in family communication who applied their knowledge to family dynamics within cancer care.
Goldsmith and colleagues addressed caregiver communication types in cancer care and their implications for support and intervention.1 The authors identified four caregiver communication styles that are predictive of what we as oncology nurses observe in clinical practice.
Caregivers who function as Manager see their role as an extension of the physician. They lead conversations about cancer by focusing on their knowledge that is often gleaned from the Internet, questioning healthcare providers, and speaking to others who have had cancer experiences. Conversations about the patient are dominated by the caregiver’s strength of evidence and assumed expertise about the disease.
Carrier caregivers rely on their loved one with cancer to determine the course of care. Yet, they prefer to speak with the cancer care team about what is transpiring (versus immediate family members) and often dutifully adhere with professional recommendations. Carrier caregivers often assert their desire to provide total care of the patient and negate requests to offer support by other family.
Partner caregivers highly integrate both the patient and family perspectives in decision making. Dying and death are part of family conversations and the family as a whole are capable of navigating conflict and difference in opinion.
Lone caregivers are characterized by emotional detachment and minimal conversation. They operate as a single actor in the caregiving enterprise and are heavily invested in short-term biomedical solutions and physical restoration. They do not discuss pain, quality of life, or advance directives, but instead focus on the most immediate physical issue such as weight loss, low platelet count, or hydration compromise. “Lone” caregivers are generally unsatisfied with their healthcare experiences.
Why is an appreciation of these family dynamics important for oncology nurses? Primarily because family communication style during the cancer experience is an extension of what has transpired prior to diagnosis. Typically these norms do not change postcancer. With a greater appreciation of usual behavior, we can predict what will transpire in the clinical arena. Additionally, while we may engage in efforts to promote what we perceive as a more effective coping strategy, most hold on to their old norm. So consider how you label family caregiving.
- Goldsmith J, Wittenberg E, Platt CS, et al. (2016). Family caregiver communication in oncology: advancing a typology. Psycho-Oncology, Apr;25(4):463-70.