title: Challenges in providing family-centered support to families in palliative care.
abstract: BACKGROUND
  Supporting the family-as-a-whole presents challenges in palliative care, although family meetings are increasingly used in routine practice. The Family Focused Grief Therapy (FFGT) Model guides clinicians in using a range of intervention strategies.
  
  
  OBJECTIVE
  To examine the therapists' techniques used in assessing 'at risk' families in palliative care to better illuminate what helps and what remains challenging.
  
  
  METHODS
  Recorded sessions 1 and 2 were coded using the FFGT fidelity coding measure, with its glossary of definitions. Inter-rater reliability between three coders was satisfactory at 88%. Frequencies of strategy utilization were computed, with extraction of examples of both successful and problematic approaches.
  
  
  METHODS
  From within a larger study of family therapy during palliative care at a comprehensive cancer center, the first two sessions (n = 144) delivered to 74 families (299 individuals) by 32 therapists were coded and analyzed.
  
  
  RESULTS
  Therapists readily explored the story of illness and families' ways of coping (97%) and assessed communication and cohesiveness in the majority. Exploration of relational patterns occurred in 89% of sessions, use of a genogram in 80%, understanding members' roles in 65% and family values and beliefs in 62%. Less use was made of summaries (39%), family mottos (34%), exploration of family conflict (35%) and the formalization of a comprehensive family treatment plan (20%).
  
  
  CONCLUSIONS
  Challenges exist in therapy with difficult families. Therapy in the home brings special issues. Therapists can apply most of the interventions prescribed by the FFGT model.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Del Gaudio
authors.forename: Talia I
authors.initials: TI
authors.lastname: Zaider
authors.forename: Moriah
authors.initials: M
authors.lastname: Brier
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005196:Family Therapy / Q000379:methods* / Q000592:standards; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D012720:Severity of Illness Index
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