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. Aim To examine the therapists’ techniques used in assessing ‘at risk’ families in palliative care to better illuminate what helps and what remains challenging. Method 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. Setting/participants 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.

Os Cuidados Paliativos Domiciliários, a Alimentação e os Familiares-Cuidadores

“…Os familiares de doentes em situações paliativas são profundamente afetados pelos desafios e alterações que a doença impõe (Del Gaudio, Zaider, & Brier, 2011;Gutierrez, Cambraia, & Fratezi, 2016). Se por um lado alguns familiares possuem uma capacidade de resiliência suficientes para aceitarem a doença e a morte, por outro lado são também muitos os familiares que apresentam distress (Blanchard, Albrecht, & Ruckdeschel, 1997 (Kristjanson, & Aoun, 2004).…”

Necessidades dos familiares de doentes terminais em cuidados paliativos: Revisão crítica da literatura

“…Apesar de muitas famílias apresentarem uma resiliência notória na adaptação à fase terminal da doença (Gaudio, Zaider, Brier, & Kissane, 2011) e retirarem benefícios pessoais enquanto cuidadoras do doente (Totman et al, 2015), outras apresentam níveis de distress significativos (Gaudio et al, 2011), com franca morbilidade psiquiátrica (Askari et al, 2012;Totman et al, 2015). Ainda assim, são muitas as necessidades dos familiares que continuam a não ter resposta por parte dos profissionais de saúde.…”

Family focused grief therapy: a versatile intervention in palliative care and bereavement

“…Delivery of the therapy is standardised with a manual, extensive training and supervisory support (Chan et al , 2004). Therapists have been masters and PhD-level clinicians with post graduate training as family therapists (Del Gaudio et al , 2011). In addition, therapists are trained specifically in Family Focused Grief Therapy at a one-day workshop utilising role-play exercises.…”

“…In addition, therapists are trained specifically in Family Focused Grief Therapy at a one-day workshop utilising role-play exercises. Fidelity to the treatment model is further ensured through weekly supervisions, during which therapists receive a feedback report highlighting areas of low and high fidelity (Del Gaudio et al , 2011). …”

“…FFGT has, in response, evolved into a versatile model of support that can be delivered in the outpatient setting, at the hospital bedside, or in the home. Although therapists can struggle to clarify and maintain the structure of therapy when it occurs outside of the consulting room (Del Gaudio et al , 2011), the flexibility and transportability of this model have become essential to its feasibility. We have written at length elsewhere about guidelines for the safe conduct of therapy in the home (Kissane & Bloch, 2002).…”