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Family Functioning Predicts End-of-Life Care Quality in Patients With Cancer: Multicenter Prospective Cohort Study
Myung Kyung Lee1, Young Ho Yun
1Author Affiliations: College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu (Dr Lee); and Institute of Health Policy and Management, Seoul National University College of Medicine (Dr Yun), Republic of Korea.
Background:
Treating patients with cancer within a family setting is the accepted standard of care and a hallmark of end-of-life (EoL) quality of care (QoC).
Objective:
The aim of this study was to determine whether family caregiver functioning predicts EoL QoC received by terminally ill patients with cancer.
Methods:
Family caregivers of terminally ill patients with cancer (n = 264) were enrolled from oncology inpatient and outpatient units of 12 large hospitals located in different regions throughout South Korea. Caregivers were administered self-reported questionnaires about family functioning and EoL QoC at the time of an incurable cancer diagnosis, 4 to 6 weeks later, and again 2 to 3 months later. Family functioning and QoC were measured using the family Apgar and Quality Care Questionnaire-End of Life scales, respectively.
Results:
Improved adaptability to resource sharing and attention received predicted improved family relationships for the 3 time points. Increased participation in decision making and communication predicted improved individualized care and family relationships for the 3 time points. Increased affection predicted improvements in dignity-conserving care and family relationships for the 3 time points. Improved resolution regarding sharing time and satisfaction with commitments predicted increases in all QoC domains for the 3 time points, including dignity-conserving care, care by healthcare professionals, individualized care, and family relationships.
Conclusions:
Family functioning may contribute to improved EoL QoC of patients with terminal cancer.
Implications For Practice:
Patients' family caregivers are a valued source of affection and communicative support, improving EoL QoC. More family-oriented cancer support systems can better maintain the effectiveness of QoC until EoL.