Communication behaviors and patient and caregiver emotional concerns: a description of home hospice communication.

PURPOSE/
OBJECTIVES: To identify and describe communication behaviors used by hospice nurses when eliciting and addressing concerns of patients with cancer and their caregivers.
DESIGN: Secondary analysis.
SETTING: Home hospice in Salt Lake City, UT. SAMPLE: Audio recordings from seven patient and caregiver dyads and five hospice nurses.
METHODS: Audio recordings were coded using the Roter Interaction Analysis System for patient and caregiver concern statements indicating negative affect and distress and the surrounding nurse communication behaviors. Concern content was categorized using domains developed by the National Consensus Project for Quality Palliative Care. MAIN RESEARCH VARIABLES: Patient and caregiver concern statements and nurse communication behaviors.
FINDINGS: 180 patient and caregiver speaking turns containing concerns were identified across 31 hospice visits. Patients and caregivers expressed at least one concern in the vast majority of visits. The most prevalent distress areas reflected psychological and physical issues. Nurses used proportionally more positive emotion statements before patient and caregiver concerns, compared to the visit overall. Nurses asked proportionally more physical questions after concern statements. Nurses also used more emotional responses before and after patient and caregiver concerns, relative to the entire visit.
CONCLUSIONS: Patients with cancer and caregivers frequently talk about distressing issues. Hospice nurses use specific communication behaviors to elicit and address those issues. IMPLICATIONS FOR NURSING: Home hospice provides a venue to examine nurse communication behaviors used to elicit and respond to patient and caregiver distress. These strategies could be taught to nurses who encounter patient distress less frequently or are less comfortable with emotional conversations.