Clinical and Communication Factors Associated With Family Conflict in Palliative Care Units: A Survey of Bereaved Families in Japan

Family conflict is a common problem in palliative care and has been identified as a potential barrier to providing appropriate care. Several demographic factors associated with family conflict have been reported; however, associated clinical factors, including symptoms, treatments, and communication, remain to be elucidated. The aim of this study was to identify symptoms, treatments, and communication factors associated with family conflict in palliative care units (PCUs). We used matched data for deceased patients from a prospective cohort study conducted between January 2017 and December 2017 of cancer patients admitted to PCUs and their bereaved families from a nationwide cross-sectional questionnaire survey in Japan. We assessed family conflict using the Outcome-Family Conflict Scale. We sent out 667 questionnaires, of which 443 (66.4%) were returned. We excluded 81 family members who refused to participate; therefore, we analyzed 362 (81.7%) responses. The mean age of the patients who died of cancer was 73.9 ± 11.3 years, and 51.9% were men. Multivariate logistic regression revealed a significant association between rapid deterioration of the patient's condition, resulting in death within 1-2 days, and family conflict about what is meant by "a good death" (p = 0.044, odds ratio: 2.66), and the presence of family members who insulted or yelled at other family members (p = 0.005, OR: 3.22). In addition, a significant association was found between the confirmation of the family's wishes regarding CPR during hospitalization and family conflicts about healthcare decisions for their relative (p = 0.013, OR: 0.46), about the way a member was treating their relative (p = 0.014, OR: 0.43), and about what is meant by "a good death" (p = 0.028, OR: 0.38). Our findings suggest that abrupt clinical deterioration is associated with family conflict. Confirming patients' and families' wishes regarding CPR during hospitalization may help reduce family conflict in PCUs.