title: Correlates and Predictors of Conflict at the End of Life Among Families Enrolled in Hospice.
abstract: BACKGROUND
  Despite the palliative care mandate to view family as the unit of care, and the high prevalence and detrimental consequences of conflict at the end of life, little research has been conducted with hospice families to understand what contributes to family conflict.
  
  
  OBJECTIVE
  Using a recently generated explanatory matrix of family conflict at the end of life, this study sought to identify the correlates and predictors of family conflict.
  
  
  METHODS
  As part of a larger mixed methods cross-sectional study, a 100-item survey was administered to 161 hospice family caregivers enrolled in a Medicare/Medicaid certified non-profit hospice organization located in the Midwest U.S.
  
  
  RESULTS
  Although overall levels of conflict were relatively low, 57% of hospice caregivers reported experiencing some family conflict at the end of life. Contextual variables associated with family conflict included a history of family conflict, female gender, younger caregiver age, presence of children in the home, and less advance care planning discussions. Significant main effects in the prediction of family conflict in the final hierarchical multiple regression model included prior family conflict, caregiver age, caregiver gender, advance care planning discussions, family "coming out of the woodwork," communication constraints, and family members asserting control. The model explained 59% of the variance in family conflict.
  
  
  CONCLUSIONS
  Results support the multidimensional theoretical model of family conflict specifying the importance of the family context, key conditions that set the stage for conflict, and essential contributing factors. Implications for routine assessment and screening to identify families at risk and recommendations for future research are highlighted.
authors.affiliation: School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA. Electronic address: ejkramer@wisc.edu.
authors.forename: Betty J
authors.initials: BJ
authors.lastname: Kramer
authors.affiliation: Department of Sociology and Social Work, University of Wisconsin-Stevens Point, Stevens Point, Wisconsin, USA.
authors.forename: Amy Z
authors.initials: AZ
authors.lastname: Boelk
mesh_terms: D017028:Caregivers / Q000523:psychology*; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D006738:Hospices; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010166:Palliative Care / Q000523:psychology; D012044:Regression Analysis
keywords: Family conflict; caregiver; end of life; hospice; palliative care