Family Caregiver Communication and Decision Making in Korean End-of-Life Care Settings

In end-of-life care settings, family caregivers (FC) play an essential role as primary communicators with clinicians concerning patient care preferences. However, few studies have examined FC-clinician communication quality and identified the effects of communication quality on FC outcomes with a specific focus on end-of-life care settings. Also, no studies have established the role of FC decision-making quality in the relationship between FC-clinician communication quality and FC outcomes. Therefore, this study examined FC-clinician communication quality and its influence on FC depression, anxiety, and quality of life in Korean hospital-based hospice and palliative care settings. FC decision-making quality was addressed by measuring decisional conflict and decision regret. Using a cross-sectional design, 200 Korean FCs completed a web-based online questionnaire. Participants completed the Quality of Communication Scale, Center for Epidemiological Studies-Depression, Zung's Self-rating Anxiety Scale, Decisional Conflict Scale, Decision Regret Scale, and Caregiver Quality of Life Index-Cancer. Descriptive, bivariate, multivariate multiple regression analyses, and structural equation modeling were performed. FCs rated communication quality with physicians during patient end-of-life care as 6.00 (SD=1.64) of 10.0 and nurses as 6.16 (SD=2.13) of 10.0. FCs' mean depression score was 32.19 (SD=8.51) of 60, and the mean anxiety score was 47.26 (SD=9.01) of 80. Their mean quality of life score was 67.69 (SD=15.96) of 140. Concerning FCs’ decision-making quality, the mean decisional conflict score was 49.31 (SD=18.09) of 100 and the mean decision regret score was 44.63 (SD=18.04) of 100. Multivariate regression analysis showed that FCs reporting better FC-physician communication quality experienced less depression and anxiety and better quality of life after adjusting for demographic, clinical, and treatment location covariates. The study findings highlight the need for interventions to enhance communication between FCs and physicians and other clinicians to improve critical caregiver outcomes. Structural equation modeling showed that decisional conflict mediated the effect of FC-physician communication quality on FC depression and that decision regret mediated the impact of FC-physician communication quality on FC quality of life. Additional research is required to develop strategies for supporting FCs in Korean end-of-life care settings.