title: Unmet desire for caregiver-patient communication and increased caregiver burden.
abstract: OBJECTIVE
  To examine the adequacy of caregiver-patient communication in serious illness and its relationship to caregiver burden.
  
  
  METHODS
  Cross-sectional cohort study.
  
  
  METHODS
  Participants' homes.
  
  
  METHODS
  One hundred ninety-three persons aged 60 and older seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease and their caregivers.
  
  
  METHODS
  Communication concerns, measured in terms of agreement with statements regarding desire for and difficulty with communication about the patient's illness. Caregiver burden, measured using a 10-item subset of the Zarit Burden Inventory, with scores ranging from 0 to 40 and higher scores indicating greater burden.
  
  
  RESULTS
  Of caregivers, 39.9% desired more communication, and 37.3% reported that communication was difficult. Of patients, 20.2% desired more communication, and 22.3% reported that communication was difficult. Disagreement regarding communication concerns was frequent in caregiver-patient pairs; of caregivers who desired more communication, 83.1% of patients did not, and of patients who desired more communication, 66.7% of caregivers did not. Caregivers who desired more communication had significantly higher caregiver burden scores than did caregivers who did not (9.2 vs 4.7, P<.001), even after adjusting for patient's diagnosis, income, and functional status and caregivers' age, sex, and relationship to the patient.
  
  
  CONCLUSIONS
  A large proportion of caregivers and seriously ill older persons had an unmet desire for increased communication, although they frequently disagreed with each other about this desire. Caregivers' desire for increased communication may be a modifiable determinant of caregiver burden.
authors.affiliation: Clinical Epidemiology Unit, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut 06516, USA. terri.fried@yale.edu <terri.fried@yale.edu>
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: John R
authors.initials: JR
authors.lastname: O'Leary
authors.forename: Amy L
authors.initials: AL
authors.lastname: Byers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D017028:Caregivers / Q000523:psychology*; D015331:Cohort Studies; D003142:Communication; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000534:rehabilitation; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D020380:Needs Assessment; D009369:Neoplasms / Q000534:rehabilitation; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation