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22-11-2011 | Psychology | Article

Challenges still exist in the provision of family-centered palliative care


Free abstract

MedWire News: Analysis of the use of Family Focused Grief Therapy (FFGT) illustrates the successes and remaining challenges for therapists providing palliative care to "at risk" families.

"Although the call for family support during palliative care is well-recognized today, limited evidence exists to inform the clinicians about how best to intervene to meet the family's psychosocial needs," write David Kissane and colleagues at the Memorial Sloan-Kettering Cancer Centre in New York, USA.

Their study, published in the journal Palliative Medicine, comprised an analysis of the first two therapy sessions delivered to a sample of 74 families by 32 therapists. All families were categorized as "at risk" according to the Family Relationships Index, used as a standard indicator of family functioning.

All patients had stage IV cancer and their mean age was 56.2 years; 58% were female. The main types of cancer the patients had were gastrointestinal (68.8%), melanoma (7.8%), breast (4.5%), and lung (4.5%).

The families were randomly assigned to receive either six (45.2%) or 10 (54.8%) FFGT sessions. FFGT is designed to improve family functioning and therefore help the coping and grieving processes. It is divided into three phases of therapy: assessment, intervention, and consolidation. By focusing on the first two sessions, this analysis looked only at the assessment phase of FFGT.

The therapist explored the story of illness and the family's way of coping in almost all sessions (97%) and explored relational patterns within the family in 89% of sessions. Discussion using a genogram to assess the historical pattern of coping occurred in 80% of the sessions. Understanding family members' roles occurred in 65% of sessions, and family values and beliefs in 62%. The therapists made less use of summaries (39%), family mottos (34%), exploration of conflict (35%), and formalization of a treatment plan (20%).

The therapists provided details of the challenges they faced. For example, one therapist said "it was hard to sit through the pain and continue to find the balance of my own emotions."

"Overall, therapists were able to adhere to the majority of interventions prescribed, suggesting that FFGT can be applied by therapists practicing in the community," say Kissane and team. "Interventions that were more challenging to implement included: assessing family conflict; constructing a family genogram; and formalizing a treatment plan."

On the future implications of their research, they write: "An important future step will be to look statistically at whether the therapist behaviors described are linked to specific therapy outcomes."

By Chloe McIvor

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