Abstract
As patients transition to hospice/palliative care, family members face the challenge of engaging in conversations about prognosis and death. Although conversations about death and dying are optimal during hospice care, few families are able to speak openly and candidly about disease and illness and little is known about the impact of family communication patterns on the primary caregiver's stress and ability to cope. Family Communication Patterns Theory was used as a framework to investigate caregiver concerns related to family roles and responsibilities during hospice care. Audio-recorded discussions were reviewed for caregiver concerns involving 1 or more family members, and thematic coding was used to analyze the data. This study empirically identified 4 types of hospice family caregivers (manager, carrier, partner, and loner) through family communication patterns. With the exception of partner caregiver types, family caregivers deferred to the hierarchical role within the family (conformity) over communication (conversation) during hospice. Conformity in family communication did not equate with family agreement or open communication. Families emphasized communication patterns in line with family hierarchical roles rather than engaging in conversation and disclosure. Caregiver typologies can guide clinicians in using more sculpted and appropriate communication skills and practices to enable care and inclusion of family caregivers.