Communication Between the Nurse and Family Caregiver in End-of-Life Care: A Review of the Literature

Susan E. Lowey, MS, RN, CHN, BC

Disclosures

Journal of Hospice and Palliative Nursing. 2008;10(1):35-45. 

In This Article

Abstract and Introduction

Little research describes communication among the nurse, patient, and family at the very end of life. How do nurses communicate imminent death to loved ones of a terminally ill patient whose death is expected but not fully anticipated? A systematic review of the literature was performed on four subcategories that are interrelated within this phenomenon. The nurse-patient relationship, family caregiver needs, communication, and experience of dying in end-of-life/hospice care were examined. Common themes that emerged included the similarities between the nurse-patient relationship and communication, the effectiveness of using a team approach in communication, the needs of caregivers for more effective communication and information regarding end-of-life care, and maintaining closeness and normalcy with their loved one until death. No studies focused specifically on the nature of nurse-family communication during the final days or hours of life, which would be an area for future research to explore.

In 2005, hospice programs were involved in the care of approximately one third of all deaths in the United States, and more than 1.2 million people received hospice care services, which was an increase of more than 150,000 patients from the previous year.[1] Communication among healthcare providers, patients, and their families regarding end-of-life (EOL) care is an important determinant in providing quality care in the setting of choice for patients with terminal illnesses. Numerous studies have examined communication between the physician and patient in the context of palliative and EOL care in regards to exploring prognosis and life expectancy.[2,3,4] These studies primarily focus on delivering "bad news" and discussing palliative care early in the terminal illness trajectory. Little research describes communication among the nurse, patient, and family at the EOL. How do nurses communicate imminent death to the loved ones of a terminally ill patient whose death is expected but not fully anticipated? What are the needs of families during those final days of life? How does communicating information on naturally occurring processes, potential symptoms, and management strategies at the EOL provide comfort and emotional support to patients and families?

The purpose of this article is to understand the phenomenon of communication between the nurse and family caregiver during the last few days of life through examination of the literature. It explores the nature surrounding nurses' communication of sensitive information during this difficult time and how it is perceived by family caregivers. Three questions are addressed:

  1. What are the needs of family caregivers at the EOL regarding communication?

  2. How is imminent death communicated to family caregivers by the nurse and what is the nature of that interaction?

  3. What is the role of the nurse in the final interactions with the patient and family at EOL?

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