Typology of Perceived Family Functioning in an American Sample of Patients With Advanced Cancer

Abstract

Context Poor family functioning affects psychosocial adjustment and the occurrence of morbidity following bereavement in the context of a family’s coping with advanced cancer. Family functioning typologies assist with targeted family-centered assessment and intervention to offset these complications in the palliative care setting. Objectives Our objective was to identify the number and nature of potential types in an American palliative care patient sample. Methods Data from patients with advanced cancer (N = 1809) screened for eligibility for a larger randomized clinical trial were used. Cluster analyses determined whether patients could be classified into clinically meaningful and coherent groups, based on similarities in their perceptions of family functioning across the cohesiveness, expressiveness, and conflict resolution subscales of the Family Relations Index. Results Patients’ reports of perceived family functioning yielded a model containing five meaningful family types. Conclusion Cohesiveness, expressiveness, and conflict resolution appear to be useful dimensions by which to classify patient perceptions of family functioning. “At risk” American families may include those we have called hostile, low-communicating, and less-involved. Such families may benefit from adjuvant family-centered psychosocial services, such as family therapy.

Correlates and Predictors of Conflict at the End of Life Among Families Enrolled in Hospice

“…Three contextual variables associated with conflict that also were reported in recent studies include prior family conflict, 12 younger age, 12,26 and female gender. 26 Although there was no relationship between conflict and advance directives, conflict was associated with advance planning discussions. Recent evidence suggests that more highly functioning and emotionally supportive families are more likely to have such discussions.…”

Family Relationships and Psychosocial Dysfunction Among Family Caregivers of Patients With Advanced Cancer

“…In a cross-sectional study of 191 patient-caregiver dyads, lower levels of cohesiveness (family members' involvement in the family), expressiveness (family members' willingness to express their emotions openly) and conflict resolution (family's ability to solve disagreements) predicted depressive symptoms in both lung cancer patients and their caregivers (13). Previous studies investigating family functioning have shown that cohesiveness is the primary indicator of well-functioning families types (13-17). However, little is known about the relationship between family function and caregiver burden and well-being.…”

“…In relation to the FRI, the cluster solution is generated based on the 3 FRI subscales (cohesiveness, expressiveness, conflict resolution). Cluster analysis of the FRI has been conducted in American, Japanese and Australian samples (14, 16, 17). The number of components generated from the cluster solutions varies from a 3 cluster solution (16) to a 5 cluster solution (12, 14, 17).…”

“…For this reason, we employ the same cluster method as used by one the main studies published on this topic – an investigation by Schuler et al . (2014) (17). In addition to validating previous findings, this study will investigate differences in caregiver well-being and caregiving burden across family types (20-24).…”

“…Finally, this study aims to examine the reproducibility of cluster analyses. We hypothesize that the cluster model will generate five clusters as in Schuler et al (2014) given the similarities in the samples and cluster method used (17). In line with previous research, we hypothesize that caregivers of family types with low levels of cohesiveness will have the most psychosocial dysfunction, whereas caregivers of family types with high levels of cohesiveness will have the least.…”