Communication behaviors and patient and caregiver emotional concerns: a description of home hospice communication.
OBJECTIVE
To identify and describe communication behaviors used by hospice nurses when eliciting and addressing concerns of patients with cancer and their caregivers.


METHODS
Secondary analysis.


METHODS
Home hospice in Salt Lake City, UT.


METHODS
Audio recordings from seven patient and caregiver dyads and five hospice nurses.


METHODS
Audio recordings were coded using the Roter Interaction Analysis System for patient and caregiver concern statements indicating negative affect and distress and the surrounding nurse communication behaviors. Concern content was categorized using domains developed by the National Consensus Project for Quality Palliative Care.


METHODS
Patient and caregiver concern statements and nurse communication behaviors.


RESULTS
180 patient and caregiver speaking turns containing concerns were identified across 31 hospice visits. Patients and caregivers expressed at least one concern in the vast majority of visits. The most prevalent distress areas reflected psychological and physical issues. Nurses used proportionally more positive emotion statements before patient and caregiver concerns, compared to the visit overall. Nurses asked proportionally more physical questions after concern statements. Nurses also used more emotional responses before and after patient and caregiver concerns, relative to the entire visit.


CONCLUSIONS
Patients with cancer and caregivers frequently talk about distressing issues. Hospice nurses use specific communication behaviors to elicit and address those issues.


CONCLUSIONS
Home hospice provides a venue to examine nurse communication behaviors used to elicit and respond to patient and caregiver distress. These strategies could be taught to nurses who encounter patient distress less frequently or are less comfortable with emotional conversations.
College of Nursing, University of Utah in Salt Lake City.
Margaret F
MF
Clayton
College of Nursing, University of Utah in Salt Lake City.
Maija
M
Reblin
School of Medicine, University of Utah in Salt Lake City.
McKenzie
M
Carlisle
College of Nursing, University of Utah in Salt Lake City.
Lee
L
Ellington
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D017051:Hospice Care / Q000523:psychology*; D064946:Hospice and Palliative Care Nursing / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D009723:Nurse-Patient Relations; D013315:Stress, Psychological / Q000523:psychology; D013637:Tape Recording; D014589:Utah
anxiety; caregivers; communication; end-of-life; family; hospice