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Understanding cancer caregiver burden over time: Dyadic assessments of family cohesion,conflict and communication
Affiliation:1. Department of Health Behavior and Policy, Virginia Commonwealth University, 830 East Main Street, Richmond, VA 23219, USA;2. College of Public Health and Social and Behavioral Sciences, Temple University, Philadelphia, USA;1. Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany;2. Institute for Medical Sociology & Rehabilitation Science, Charité – University Hospital Berlin, Berlin, Germany;3. Drug Commission of the German Medical Association, Berlin, Germany;4. Center for Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Germany;1. Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel and Clalit Health Services, Southern District, Beer-Sheba, Israel;2. Department of Counseling and Human Development, University of Haifa, Haifa, Israel;1. Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia;2. Pharmacy Department, Perth Children’s Hospital, Perth, Australia;3. Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Perth, Australia;4. Perioperative Medicine, Telethon Kids Institute, Perth Australia;5. Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia;6. Pharmacy Department, Sir Charles Gairdner Hospital, Nedlands, Australia;1. Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA;2. Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA;3. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA;1. Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA;2. Jump Trading Simulation and Education Center, OSF Healthcare, Peoria, IL, USA;3. Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA;4. Department of BioEngineering, University of Illinois Grainger College of Engineering Urbana, IL, USA;5. Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL, USA;6. Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA;7. Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA;8. Center for Connected Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA;1. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA;2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA;3. College of Design, Architecture, Art, and Planning, University of Cincinnati, Cincinnati, OH, USA
Abstract:ObjectivePreviously we identified three distinct cancer communication concordance groups among cancer patient-caregiver dyads. This secondary analysis examined patient and caregiver reports of family functioning (cohesion and conflict) as associated with cancer communication concordance and assessed each as independent predictors of perceived caregiver burden among hematological cancer caregivers.MethodsA case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Using the previously identified communication groups this analysis prospectively examines patient and caregiver perceptions of family cohesion and conflict and the association with burden over time.ResultsCaregiver burden decreased over time. Caregiver, but not patient perceptions of family cohesion decreased over time; decreased cohesion and increased conflict was associated with greater cancer communication discordance.ConclusionsThis work lends further support to the use of cancer communication congruence typologies for identifying potentially vulnerable dyads. Discordant cancer communication and declining caregiver perceptions of family cohesion may represent opportunities to intervene using family focused supportive services.Practice implicationsOnly caregiver perceptions of family functioning were associated with burden therefore identifying and supporting those caregivers with worsening communication and family function is important.
Keywords:Cancer  Cancer communication concordance  CCAT-PF  Caregivers  Caregiver burden  Hematological cancer  Oncology. Family environment. Conflict  Cohesion
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