Family Relationships as Modifiable Targets for Caregiver Quality of Life in Hospice Care: A Multicenter Study

Family caregivers play a critical role in supporting patients with advanced cancer, yet their quality of life (QoL) is often adversely affected and remains insufficiently addressed in routine care. Although family relationships have been widely recognized as important in the caregiving context, their specific domains have rarely been examined in relation to caregiver outcomes. This study aimed to examine the associations between distinct domains of family relationships and caregiver QoL. A total of 170 caregivers were recruited from nine hospice units in Korea between September 2021 and March 2024. for this multicenter study. The Family Relationship Assessment Scale (FRAS) and the Korean version of the Caregiver QOL Index-Cancer (CQOLC-K) were used to assess family relationships and caregiver QoL, respectively. Multivariate regression analyses were performed to evaluate the associations between specific domains of family relationships and caregiver QoL. Family relationship domains were differentially associated with caregiver QoL. Overall family relationship scores were positively associated with QoL (β = 0.30, p = 0.004), while family conflict showed the strongest negative association (β = -1.03, p = 0.001). In contrast, family support was associated with better positive adaptation (β = 0.24, p = 0.027). The associations between family relationships and QoL were more pronounced among vulnerable caregivers, including those who were younger, unemployed, had lower social support or resilience, or were dissatisfied with care. Family relationships, particularly conflict and support, are important correlates of caregiver QoL. Incorporating the assessment of family relationship domains helps identify caregivers at increased risk and informs the development of more family-centered supportive approaches in palliative oncology care.