Communication about end -of -life topics between terminally ill cancer patients and their family members

Communication has increasingly been discussed as a critical component of endof-life (EOL) care. To date, the focus has primarily been on patient-physician communication with little attention given to the patient-family member relationship. The present study sought to fill this gap by clarifying the nature of communication about EOL topics between terminally ill cancer patients and their family members, as well as the impact of EOL communication on patients\u27 psychological distress. A newly designed measure, the Patient-Family Member Illness Questionnaire (PFIQ), assessed dyad\u27s desire for communication and amount of previous communication across 21 end-of-life topics. Additionally, patients were assessed for levels of anxiety, depression, hopelessness, and quality of life. Although desire for EOL communication and the amount of previous EOL communication were modest, they were significantly associated with patients\u27 psychological distress levels. Patients\u27 desire for EOL communication was significantly associated with anxiety and to a lesser extent depression. In multiple regression models, amount of previous EOL communication was significantly predictive of depression, hopelessness and quality of life, and to a lesser extent anxiety. Family member participation in the present study influenced the effect of previous communication on patients\u27 psychological distress levels. More specifically, greater amounts of previous communication was associated with lower levels of psychological distress when family members participated, but was associated with higher levels of psychological distress when family members did not participate. When compared to alignment of patients\u27 and family members\u27 desire for communication, amount of previous communication was more strongly associated with depression and hopelessness, and to a lesser extent anxiety; no significant differences in impact were noted for quality of life scores. Although further validation of the PFIQ is needed, these results suggest that interventions focused on fostering patient-family member EOL communication may help reduce some of the psychological distress common at the end-of-life. These interventions may need to be targeted to specific sub-groups of terminally ill patients given the differential impact of EOL communication on distress levels as a function of family member participation. Longitudinal studies will assist in identifying the ideal points of intervention across the illness trajectory