Determinants and Impact of Distinct Family-Conflict Trajectories for Family Caregivers Both before and after Terminally Ill Cancer Patients’ Death

Families play a significant role in end of life (EOL) care for terminally ill cancer patients and our society at large. EOL caregiving is imbedded in a broader family context, one that goes beyond the dyad. Family members may not share the same attitudes/philosophy toward caregiving to an ill family at EOL, take a fair share of the caregiving tasks, and well appreciate each other’s contribution to caregiving, thereby resulting in family conflict. High family conflict in EOL care exacerbates caregivers’ burden and increases risk for depression and prolonged grief. Yet, scant research has investigated the occurrence, impact, and determinants of family conflict at EOL. No family conflict studies while providing EOL caregiving existed with a longitudinal approach and no family-conflict trajectory classes has been identified, despite each family experiences the member’s EOL in its own way and may not perceive family conflict at EOL as homogeneous. Therefore, the purposes of this study are to (1) identify the unique trajectories of family conflict experienced by family caregivers (FCs) over patients dying process, (2) characterize FCs within each unique trajectory of family conflict in terms of selected context, conditions, and contributing factors by arranging time-variant, independent variables in a distinct time sequence, and (3) examine the impact of unique trajectories of family conflict on caregiving burden and depressive symptoms while providing EOL caregiving and their likelihood of complicated grief over the first year of bereavement. A prospective, longitudinal study will be conducted over three years on a convenience sample of 345 FCs of terminally ill cancer patients. Well-established instruments will be used to measure family conflict (Family Conflict Scales), caregiving burden (Caregiver Reaction Assessment), depressive symptoms (CESD), complicated grief (Inventory of Complicated Grief—Revised), and predictors of family conflict (family context, conditions, and contributing factors). Perceived family conflict and potential predictors of family conflict, as well as caregiving burden and depressive symptoms experienced will be measured at baseline. FCs will be continually followed up every two weeks until the death of their relative through 6 and 13 months postloss to measure complicated grief. Latent class analysis with a continuous latent class indicator (total FCS scores) will be conducted to identify the unique trajectories of family conflict (Aim 1). Multinomial logistic regression model with the generalized estimating equation (GEE) will be used to characterize FCs within each family-conflict trajectory (Aim 2). Multivariate linear and logistic regression models with the GEEs will be conducted to of identified unique trajectories of family conflict on caregiving burden and depressive symptoms while providing EOL caregiving and their likelihood of complicated grief over the first year of bereavement (Aim 3), respectively. By appropriately identifying the unique trajectories of family conflict and characterizing primary family caregivers within each unique family-conflict trajectory by potentially modifiable factors, may shed light on future directions of clinical interventions and health policies aimed at fostering family caregivers’ ability to recognize and resolve conflict to improve not only the family environment and care-related decisions but the caregiver’s mental health as well.

Project ID:PC10901-0712
External Project ID:MOST107-2314-B182-064-MY3