This study examined the phenomenon of avoidance of family communication about cancer. Thirty-seven Stage III or IV lung cancer patients and 40 caregivers, including 24 primary and 16 secondary caregivers, were interviewed; a total of 26 families were studied. The interviews were audiotaped and transcribed. Analysis of the interviews indicated that two thirds of the families (65%) experienced communication problems. The avoidance of family communication was associated with several underlying thought processes: avoidance of psychological distress; desire for "mutual protection;" and belief in positive thinking. Family communication was further hindered by the increasing difficulty of issues inherent to late-stage cancer. The adverse impact of communication avoidance and the implications of our findings are discussed.

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The study examined the ethnic ratio of 16 DSM-III mental disorders among White, Black, Hispanic, and Asian Americans. A total of 18,126 residents from 5 sites and 2,939 residents from the Epidemiological Catchment Area's Los Angeles site were studied separately. Logistic regression analysis was performed. Results showed that Blacks were significantly less likely than Whites to have major depressive episode, major depression, dysthymia, obsessive-compulsive disorder, drug and alcohol abuse or dependence, antisocial personality, and anorexia nervosa, but they were significantly more likely than Whites to have phobia and somatization. Lifetime prevalence rates of schizophrenia, obsessive-compulsive disorder, panic, and drug abuse or dependence were significantly lower among Hispanics than among Whites. Asians also had significantly lower rates than Whites of schizophreniform, manic episode, bipolar disorder, panic, somatization, drug and alcohol abuse or dependence, and antisocial personality. Compared with the overall findings, ethnic differences at the Los Angeles site were lessened between Blacks and Whites, enhanced between Hispanics and Whites, and basically unchanged between Asians and Whites.

The findings suggest that nurses need to be aware of differences of opinion between patients with advanced cancer and their caregivers. Knowledge of family disagreements about treatment decisions can help nurses' efforts to integrate families into decision-making processes in clinical settings to facilitate family communications and improve patients' and caregivers' satisfaction with treatment decisions.

Purpose Caregivers and cancer patients frequently have conflicting and unmet communication needs. The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) is a new instrument that assesses congruence in patient-family caregiver communication for both research and clinical purposes. Methods The scale was developed using a sample of 190 lung cancer patient - caregiver pairs. Standard psychometric procedures were used to develop and test the scale including qualitative item pool development, item reduction and ascertainment of scale properties. Results The multiple correlation of the 18-item CCAT-PF scale with the longer 30-item scale was .94. All but four items had less than 20% variance accounted for when each item was regressed on the remaining 17, indicating responses to an individual item were not readily predicted by the remaining items. Test re-test reliability was 0.35 and Cronbach’s alpha was 0.49 as the CCAT-PF scale represents the sum of mostly independent items. Higher CCAT-PF scores were significantly correlated with greater patient depression, greater patient perceived family conflict, lower patient-caregiver assessment and well-being, and less expressiveness and family cohesion. For both patients and caregivers, physical, functional and emotional well-being were not associated with CCAT-PF scores. Conclusion The CCAT-PF is a brief but reliable and valid tool. Although administering both family and patient versions is optimal, administering it to a patient or family caregiver only also produces reliable information.