title: Caregiver, patient, and nurse visit communication patterns in cancer home hospice.
abstract: OBJECTIVE
  Few studies have examined the triadic communication between patients, spouse caregivers, and nurses in the home hospice setting. Thus, little is known about the types of communication patterns that unfold. The goals of the study were to, first, identify common patterns of communication in nurse-patient-caregiver home hospice visits and, second, to identify nurse, caregiver-patient dyad, and visit characteristics that predict visit communication patterns.
  
  
  METHODS
  Nurses (N = 58) and hospice cancer patient and spouse caregiver dyads (N = 101; 202 individuals) were recruited from 10 hospice agencies. Nurses audio recorded visits to patient/caregiver homes from study enrollment until patient death. All patient, caregiver, and nurse utterances from the audio recordings were coded using an adapted Roter interaction analysis system. Using identified codes, cluster analysis was conducted to identify communication patterns within hospice visits. Logistic regression was used with demographic variables to predict visit communication patterns.
  
  
  RESULTS
  Six visit communication patterns were identified and were defined largely by 2 dimensions: (1) either the patient, the caregiver, or the patient and caregiver dyad interacting with the nurse and (2) the relatively high or low expression of distress during the visit. Time until death significantly predicted several clusters.
  
  
  CONCLUSIONS
  This study leads the way in outlining triadic communication patterns in cancer home hospice visits. Our findings have implications for nursing education, letting future nurses know what to expect, and lays the foundation for future research to determine effectiveness and interventions to improve health care communication.
authors.affiliation: Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Maija
authors.identifier: http://orcid.org/0000-0003-3108-465X
authors.initials: M
authors.lastname: Reblin
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, USA.
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Clayton
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, USA.
authors.forename: Jiayun
authors.initials: J
authors.lastname: Xu
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hulett
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Latimer
authors.affiliation: Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Donaldson
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Ellington
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D064946:Hospice and Palliative Care Nursing / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing* / Q000523:psychology; D009723:Nurse-Patient Relations; D013315:Stress, Psychological / Q000523:psychology
keywords: cancer; caregiver; health communication; home hospice; longitudinal research