Maija Reblin

Social and Emotional Support and its Implication for Health

Purpose of review Recent research findings from selected publications focusing on links between social support and physical health are summarized. Recent findings Current research is extending our understanding of the influences of social support on health. Many epidemiological studies have concentrated on further linking measures of social support to physical health outcomes. A few studies are now moving into newer areas, such as emphasizing health links with support receipt and provision. Researchers are also interested in outlining relevant pathways, including potential biological (i.e. inflammation) and behavioral (i.e. health behaviors) mechanisms. Interventions attempting to apply basic research on the positive effects of social support are also widespread. Although the longer term effects of such interventions on physical health remain to be determined, such interventions show promise in influencing the quality of life in many chronic disease populations. Summary Recent findings often show a robust relationship in which social and emotional support from others can be protective for health. The next generation of studies must explain, however, why this relationship exists and the specificity of such links. This research is in its infancy but will be crucial in order to better tailor support interventions that can impact on physical health outcomes.

Hospice Nurse Communication with Patients with Cancer and their Family Caregivers

BACKGROUND Effective communication by hospice nurses enhances symptom management for the patient, reduces family caregiver burden and distress, and potentially improves bereavement adjustment. However, research has not kept pace with the rising use of hospice by patients with cancer and thus we know little about how hospice nurses communicate. METHODS The overriding objective of this pilot study was to provide insight into these in-home visits. Hospice nurses audiorecorded their interactions over time with family caregivers and patients with cancer. The communication within these tapes was coded using Roter Interaction Analysis System (RIAS) and analyzed. RESULTS We found that tape recording home hospice nurse visits was feasible. RIAS was suited to capture the general content and process of the home hospice encounter and the coded interactions show the range of topics and emotions that are evident in the dialogue. Implications and future directions for research are discussed.

Provider and recipient factors that may moderate the effectiveness of received support: examining the effects of relationship quality and expectations for support on behavioral and cardiovascular reactions

Social relationships have been shown to predict decreased risk for morbidity and mortality. However, the more precise processes underlying these associations are in need of exploration. In this study, we examined important provider (relationship quality) and recipient-related (support expectations) factors that might influence the effectiveness of receiving support on cardiovascular reactivity (CVR). Participants discussed a stressful event with either a supportive or ambivalent friend, and were either given instructions that included an explicit expectation of support provision or no expectation during the task. Behavioral coding revealed fewer emotionally supportive behaviors and marginally more negative behaviors from ambivalent friends. Receiving support from an ambivalent friend was also associated with higher systolic blood pressure reactivity compared to a supportive friend, but had no effects on diastolic blood pressure or heart rate; nor were there any significant statistical interactions with the expectation manipulation. Overall, support expectations had little influence on cardiovascular and behavioral responses. Implications for the study of received support and health are discussed along with potential mechanisms responsible for such links.

Communication Behaviors and Patient and Caregiver Emotional Concerns: A Description of Home Hospice Communication

PURPOSE/OBJECTIVES To identify and describe communication behaviors used by hospice nurses when eliciting and addressing concerns of patients with cancer and their caregivers. DESIGN Secondary analysis. SETTING Home hospice in Salt Lake City, UT. SAMPLE Audio recordings from seven patient and caregiver dyads and five hospice nurses. METHODS Audio recordings were coded using the Roter Interaction Analysis System for patient and caregiver concern statements indicating negative affect and distress and the surrounding nurse communication behaviors. Concern content was categorized using domains developed by the National Consensus Project for Quality Palliative Care. MAIN RESEARCH VARIABLES Patient and caregiver concern statements and nurse communication behaviors. FINDINGS 180 patient and caregiver speaking turns containing concerns were identified across 31 hospice visits. Patients and caregivers expressed at least one concern in the vast majority of visits. The most prevalent distress areas reflected psychological and physical issues. Nurses used proportionally more positive emotion statements before patient and caregiver concerns, compared to the visit overall. Nurses asked proportionally more physical questions after concern statements. Nurses also used more emotional responses before and after patient and caregiver concerns, relative to the entire visit. CONCLUSIONS Patients with cancer and caregivers frequently talk about distressing issues. Hospice nurses use specific communication behaviors to elicit and address those issues. IMPLICATIONS FOR NURSING Home hospice provides a venue to examine nurse communication behaviors used to elicit and respond to patient and caregiver distress. These strategies could be taught to nurses who encounter patient distress less frequently or are less comfortable with emotional conversations.

Addressing Methodological Challenges in Large Communication Data Sets: Collecting and Coding Longitudinal Interactions in Home Hospice Cancer Care

ABSTRACT In this article, we present strategies for collecting and coding a large longitudinal communication data set collected across multiple sites, consisting of more than 2000 hours of digital audio recordings from approximately 300 families. We describe our methods within the context of implementing a large-scale study of communication during cancer home hospice nurse visits, but this procedure could be adapted to communication data sets across a wide variety of settings. This research is the first study designed to capture home hospice nurse–caregiver communication, a highly understudied location and type of communication event. We present a detailed example protocol encompassing data collection in the home environment, large-scale, multisite secure data management, the development of theoretically-based communication coding, and strategies for preventing coder drift and ensuring reliability of analyses. Although each of these challenges has the potential to undermine the utility of the data, reliability between coders is often the only issue consistently reported and addressed in the literature. Overall, our approach demonstrates rigor and provides a “how-to” example for managing large, digitally recorded data sets from collection through analysis. These strategies can inform other large-scale health communication research.

Spouse cancer caregivers’ burden and distress at entry to home hospice The role of relationship quality

High-quality relationships may be protective for family caregivers. This study focuses on relationship quality categories (supportive and ambivalent) in spouse caregivers in cancer home hospice. The goals of this article are to, first, describe relationship quality categories among end-of-life caregivers and, second, test the effects of relationship quality categories on caregiver burden and distress within a stress process model. Using questionnaire data collected at entry to home hospice, we found relationship quality categories were proportionally similar to those seen in noncaregiver older adults. Relationship quality significantly predicted caregiver burden, which completely mediated the relationship between caregiver relationship quality and distress. Caregivers whose social contexts place them at risk for greater distress may benefit from increased clinical attention or intervention.

Social support needs: discordance between home hospice nurses and former family caregivers.

OBJECTIVE The two goals of our study were to (1) identify which of five types of social support (Informational, Esteem, Emotional, Tangible, Belonging) are most cited by hospice nurses and family caregivers and (2) determine the match in perception of support needs. METHOD As part of a larger multiphase project, focus groups were conducted with former family caregivers and hospice nurses to discuss their experiences of home hospice care and to gather their opinions on the important issues involved in that care. Transcripts of focus group discussions were coded for support type (Informational, Esteem, Emotional, Tangible, Belonging) based on definitions from the literature. Nurse and caregiver data were compared to assess for potential match. RESULTS Analysis of coded data suggested that nurses see different types of support to be needed in equal measure across their caseloads, while caregivers expressed priorities for some types of support. Illustrative examples of each type of support are provided and discussed. SIGNIFICANCE OF RESULTS Because matching support provided with the type of support desired has been linked to improved physical and psychological outcomes, it is important to focus on this match in healthcare populations particularly vulnerable to psychological stress, including family caregivers of home hospice patients. This research has implications for interventions to match support provision to caregiver needs, or for education for home hospice providers to ensure that they are not only sensitive to the possibility of a broad range of needs but also to the necessity to tailor care to those needs.

Strategies to Support Spirituality in Health Care Communication A Home Hospice Cancer Caregiver Case Study

Background: Although there is growing recognition of the importance of integrating spirituality within health care, there is little evidence to guide clinicians in how to best communicate with patients and family about their spiritual or existential concerns. Methods: Using an audio-recorded home hospice nurse visit immediately following the death of a patient as a case-study, we identify spiritually-sensitive communication strategies. Results: The nurse incorporates spirituality in her support of the family by 1) creating space to allow for the expression of emotions and spiritual beliefs and 2) encouraging meaning-based coping, including emphasizing the caregivers’ strengths and reframing negative experiences. Discussion: Hospice provides an excellent venue for modeling successful examples of spiritual communication. Health care professionals can learn these techniques to support patients and families in their own holistic practice. Implications for Practice: All health care professionals benefit from proficiency in spiritual communication skills. Attention to spiritual concerns ultimately improves care.

A true human interaction: Comparison of family caregiver and hospice nurse perspectives on needs of family hospice caregivers

Home hospice providers are concerned with family caregiver perceptions of the quality of care and support offered, and more research is needed to understand experiences of family caregivers and what “support” means to them. We compared perceptions of caregiver needs from family caregivers and hospice nurse care managers who participated in focus groups. Discussions were audio-recorded, transcribed, inductively coded, and qualitatively analyzed to describe patterns and themes. Caregivers described information, explanation, trust, and respect as their greatest needs. Nurses also described information as the most critical need of caregivers, followed by instruction, honesty, and reassurance. Although these concepts shared similarities, caregivers and nurses related them differently to caregiver support. Both groups focused on relationship building, suggesting 2 themes that highlighted both contrasts and mutual understanding of the importance of effective relationships: “breaking it down to build it up” and “doing to, doing for, or doing with.” Caregivers and nurses cited similar concepts as essential for successful relationships between caregivers and the hospice team, but how they described them differed, and these differences shape perceptions of support. Greater understanding of similarities and differences could inform and improve training and education programs for hospice teams.

High call volume at poison control centers: identification and implications for communication

Context. High volume surges in health care are uncommon and unpredictable events. Their impact on health system performance and capacity is difficult to study. Objectives. To identify time periods that exhibited very busy conditions at a poison control center and to determine whether cases and communication during high volume call periods are different from cases during low volume periods. Methods. Call data from a US poison control center over twelve consecutive months was collected via a call logger and an electronic case database (Toxicall®).Variables evaluated for high call volume conditions were: (1) call duration; (2) number of cases; and (3) number of calls per staff member per 30 minute period. Statistical analyses identified peak periods as busier than 99% of all other 30 minute time periods and low volume periods as slower than 70% of all other 30 minute periods. Case and communication characteristics of high volume and low volume calls were compared using logistic regression. Results. A total of 65,364 incoming calls occurred over 12 months. One hundred high call volume and 4885 low call volume 30 minute periods were identified. High volume periods were more common between 1500 and 2300 hours and during the winter months. Coded verbal communication data were evaluated for 42 high volume and 296 low volume calls. The mean (standard deviation) call length of these calls during high volume and low volume periods was 3 minutes 27 seconds (1 minute 46 seconds) and 3 minutes 57 seconds (2 minutes 11 seconds), respectively. Regression analyses revealed a trend for fewer overall verbal statements and fewer staff questions during peak periods, but no other significant differences for staff-caller communication behaviors were found. Conclusion. Peak activity for poison center call volume can be identified by statistical modeling. Calls during high volume periods were similar to low volume calls. Communication was more concise yet staff was able to maintain a good rapport with callers during busy call periods. This approach allows evaluation of poison exposure call characteristics and communication during high volume periods.