Accounts of Family Conflict in Home Hospice Care: The Central Role of Autonomy for Informal Caregiver Resilience.
Jacquelyn J Benson, Debra Parker Oliver, George Demiris and 1 others
PMID 30773970WHAT IT FOUND
Home hospice caregivers often experienced family conflict as a struggle over autonomy, especially around care decisions.
They managed it through communication, formal support, and emotional self-care, not by resolving every disagreement.
Key findings
01Nearly 50% (n = 25) of the original sample of 52 caregivers reported episodes of conflict or tension, and autonomy was the central theme.
02Caregivers most often reported conflict with patients and siblings, and care decisions were the most common area of disagreement.
03Caregivers described managing conflict through direct communication, formal support providers, and emotional self-care such as positive self-talk or accepting unresolvable conflicts.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small and mostly female, White, adult children of the patient, so it may not represent other caregivers. The calls were friendly conversations from a control group, not interviews designed to ask about family conflict, so the accounts may undercount or miss conflict. Only 25 of 52 sampled caregivers reported conflict or tension, and the analysis focused on those accounts. The subsample did not include all caregivers ultimately enrolled in the original trial. Intercoder agreement was only 40% before definitions were refined, then 80%. The study is qualitative and did not test whether any conflict-management strategy reduced conflict or improved caregiver outcomes.
Declared interests
The original trial was funded by NIH (R01NR012213). The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the caregiver strategies as tested treatments. The study analysed real-time accounts from 25 caregivers who mentioned conflict during friendly calls, not outcomes after an intervention, so it cannot show that any strategy reduced conflict or improved resilience.