The Effect of Family-Focused Grief Therapy on Family Functioning in Families with Cancer

Abstract

The diagnosis of advanced cancer affects not only the patient but also the patient’s family members. In parallel, several studies have found that families with cancer have impaired functioning. Expressiveness, cohesiveness, and conflict resolution, which are the dimensions of family functionality, are affected and cause the well-being of family members to change negatively. Although families facing cancer need an intervention aimed at improving family functioning during palliative care and bereavement, therapeutic approaches have neglected family functioning. At this point, family-focused grief therapy emerged as a preventive intervention for families at risk during this difficult process that started with the diagnosis of cancer. This study aims to examine the effect of family-focused grief the- rapy on family functioning of families with a cancer member. For this purpose, firstly, the effect of a cancer diagnosis on families and family functioning was explained, then family-focused grief therapy was discussed in the context of palliative care and the grief process.

Keywords

• Grief Therapy
• Family Therapy
• Family Functioning
• Cancer
• Family

Aile Odaklı Yas Terapisinin Kanser Hastası Olan Ailelerde Aile İşlevselliğine Etkisi

Abstract

İleri evre kanser tanısı sadece hastayı değil, aynı zamanda hastanın aile üyelerini de etkilemektedir. Paralel olarak bir dizi çalışma, kanser hastası olan ailelerin işlevselliğinde bozulma olduğunu tespit etmiştir. Aile işlevselliğinin boyutları olan ifade gücü, bağlılık ve çatışma çözme etkilenerek aile bireylerinin iyi oluş halinin olumsuz yönde değişmesine sebep olmaktadır. Kanserle karşı karşıya olan ailelerin, palyatif bakım ve yas sırasında aile işlevselliğini iyileştirmeyi amaçlayan bir müdahaleye ihtiyaç duymasına rağmen terapötik yaklaşımların aile işlevselliğini ihmal ettiği görülmek- tedir. Bu noktada, aile odaklı yas terapisi, kanser teşhisi ile başlayan bu zorlu süreç içerisinde risk altında bulunan aileler için önleyici bir müdahale olarak ortaya çıkmıştır. Bu çalışma, aile odaklı yas terapisinin kanser hastası olan ailelerin aile işlevselliğine olan etkisini incelemeyi amaçlamaktadır. Bu amaçla ilk olarak kanser teşhisinin aileler ve aile işlevselliği üzerindeki etkisi açıklanmış, daha sonra palyatif bakım ile yas sürecine değinilmesi sağlanarak aile odaklı yas terapisi literatür bağlamında tartışılmıştır.

Keywords

• Yas Terapisi
• Aile Terapisi
• Aile İşlevselliği
• Kanser
• Aile

References

1. An, E., Lo, C., Hales, S., Zimmermann, C., & Rodin, G. (2018). Demoralization and death anxiety in advanced cancer. Psycho-onco- logy, 27(11), 2566-2572. https://doi.org/10.1002/pon.4843
2. Aoun, S., Rumbold, B., Howting, D., Bolleter, A. and Breen, L. (2017). Bereavement support for family caregivers: The gap between guidelines and practice in palliative care. PLOS ONE, 12(10), p.e0184750 https://doi.org/10.1371/journal.pone.0184750
3. Areia, N., Góngora, J., Major, S., Oliveira, V. and Relvas, A. (2020). Support interventions for families of people with terminal cancer in palliative care. Palliative and Supportive Care, pp.1-9. https://doi.org/10.1017/s1478951520000127
4. Augustussen, M., Hounsgaard, L., Pedersen, M. L., Sjøgren, P., & Timm, H. (2017). Relatives’ level of satisfaction with advanced cancer care in Greenland–a mixed methods study. International journal of circumpolar health, 76(1), 1335148. https://doi.or g/10.1080/22423982.2017.1335148
5. Bakouny, Z., Assi, T., El Rassy, E., Daccache, K., Kattan, C., Tohme, A., Mouhawej, M. and Kattan, J. (2018). Factors associated with the time to first palliative care consultation in Lebanese cancer patients. Supportive Care in Cancer, 27(4), pp.1529-1533. https://doi.org/10.1007/s00520-018-4543-0
6. Beierlein, V., Bultmann, J. C., Möller, B., von Klitzing, K., Flechtner, H. H., Resch, F., ... & Bergelt, C. (2017). Measuring family fun- ctioning in families with parental cancer: reliability and validity of the German adaptation of the family assessment device (FAD). Journal of psychosomatic research, 93, 110-117. https://doi.org/10.1016/j.jpsychores.2016.11.007 Bloom, C., Slaich, B., Morales, D., Smeeth, L., Stone, P. and Quint, J. (2018). Low uptake of palliative care for COPD patients within primary care in the UK. European Respiratory Journal, 51(2), p.1701879. https://doi.org/10.1183/13993003.01879-2017
7. Boele, F. W., Rooney, A. G., Bulbeck, H., & Sherwood, P. (2019). Interventions to help support caregivers of people with a brain or spinal cord tumour. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD012582.pub2
8. Boelen, P. A., & Smid, G. E. (2017). Disturbed grief: prolonged grief disorder and persistent complex bereavement disorder. Bmj, 357. https://doi.org/10.1136/bmj. j2016

9. Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A. and Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN es- timates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68, pp.394- 424. https://doi.org/10.3322/caac.21492
10. Breen, L., Aoun, S., O’Connor, M., Howting, D. and Halkett, G. (2018a). Family Caregivers’ Preparations for Death: A Qualitative Analysis. Journal of Pain and Symptom Management, 55(6), pp.1473-1479. doi: 10.1016/j.jpainsymman.2018.02.018
11. Breen, L., Szylit, R., Gilbert, K., Macpherson, C., Murphy, I., Nadeau, J., Reis e Silva, D. and Wiegand, D. (2018b). Invitation to grief in the family context. Death Studies, 43(3), pp.173-182. https://doi.org/10.1080/07481187.2018.1442375
12. Candy, B., Jones, L., Drake, R., Leurent, B., & King, M. (2011). Interventions for supporting informal caregivers of patients in the terminal phase of a disease. Cochrane Database of Systematic Reviews, (6). https://doi.org/10.1002/14651858.CD007617. pub2
13. Chan, E., O’Neill, I., McKenzie, M., Love, A. and Kissane, D. (2004). What works for therapists conducting family meetings: treat- ment integrity in family-focused grief Therapy during palliative care and bereavement. Journal of Pain and Symptom Manage- ment, 27(6), pp.502-512. https://doi.org/10.1016/j.jpainsymman.2003.10.008
14. Delalibera, M., Presa, J., Coelho, A., Barbosa, A. and Franco, M. (2015). Family dynamics during the grieving process: a systematic literature review. Ciência & Saúde Coletiva, 20(4), pp.1119-1134. https://doi.org/10.1590/1413-81232015204.09562014
15. Dumont, I. and Kissane, D. (2009). Techniques for framing questions in conducting family meetings in palliative care. Palliative and Supportive Care, 7(2), pp.163-170. https://doi.org/10.1017/s1478951509000212
16. Fearnley, R., & Boland, J. W. (2017). Communication and support from health-care professionals to families, with dependent child- ren, following the diagnosis of parental life-limiting illness: a systematic review. Palliative medicine, 31(3), 212-222. https:// doi.org/10.1177/0269216316655736
17. Foster, T., Lafond, D., Reggio, C. and Hinds, P. (2010). Pediatric Palliative Care in Childhood Cancer Nursing: From Diagnosis to Cure or End of Life. Seminars in Oncology Nursing, 26(4), pp.205-221. https://doi.org/10.1016/j.soncn.2010.08.003
18. Garrouste-Orgeas, M., Flahault, C., Poulain, E., Evin, A., Guirimand, F., Fossez-Diaz, V., ... & Timsit, J. F. (2019). The Fami-life study: protocol of a prospective observational multicenter mixed study of psychological consequences of grieving relatives in French palliative care units on behalf of the family research in palliative care (FRIPC research network). BMC Palliative Care, 18, 1-8. https://doi.org/10.1186/s12904-019-0496-4
19. Gaudio, F., Hichenberg, S., Eisenberg, M., Kerr, E., Zaider, T. and Kissane, D. (2012). Latino Values in the Context of
20. Palliative Care. American Journal of Hospice and Palliative Medicine®, 30(3), pp.271-278. https://doi.org/10.1177/1049909112448926
21. Gaudio, F., Zaider, T., Brier, M. and Kissane, D. (2011). Challenges in providing family-centered support to families in palliative care. Palliative Medicine, 26(8), pp.1025-1033. https://doi.org/10.1177/0269216311426919
22. Glover, T., Narvel, N., Schneider, L., Horgas, A. and Bluck, S. (2018). Nursing Students’ Reactions to an Educational Experien- tial Immersion in Palliative Care. Journal of Nursing Education, 57(11), pp.675-679. https://doi.org/10.3928/01484834- 20181022-08
23. Gold, M., Dunn, L. B., Phoenix, B., Paul, S. M., Hamolsky, D., Levine, J. D., & Miaskowski, C. (2016). Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life. European Journal of Oncology Nur- sing, 20, 97-105. https://doi.org/10.1016/j.ejon.2015.06.003
24. Hu, H., Wei, W., Yi, X., Xin, L., & Liu, Y. (2017). A retrospective analysis of clinical utility of AJCC 8th edition cancer staging system for breast cancer. World journal of oncology, 8(3), 71. https://doi.org/10.14740/wjon1039e
25. Iyengar, V., Behl, A., Pillai, S. and Londhe, B. (2016). Analysis of Palliative Care Process through SAP-LAP Inquiry: Case Study on Palliative Care and Training Centre. Global Journal of Flexible Systems Management, 17(4), pp.403-416. https://doi. org/10.1007/s40171-016-0137-1
26. Jacobson, L. and Butler, S. (2013). Grief Counseling and Crisis Intervention in Hospital Trauma Units. The Family Journal, 21(4), pp.417-424. https://doi.org/10.1177/1066480713488530
27. Kilvert, A. and Fox, C. (2018). Palliative care and heart failure in diabetes. Practical Diabetes, 35(4), pp.144-148. https://doi. org/10.1002/pdi.2182
28. Kissane, D. (2017). Under-resourced and under-developed family-centred care within palliative medicine. Palliative Medicine, 31(3), pp.195-196. https://doi.org/10.1177/0269216317692908
29. Kissane, D. W., Lichtenthal, W. and Zaider, T. (2008). Family Care before and after Bereavement. OMEGA - Journal of Death and Dying, 56(1), pp.21-32. https://doi.org/10.2190/om.56.1.c
30. Kissane, D. W., McKenzie, M., Bloch, S., Moskowitz, C., McKenzie, D. P., & O’Neill, I. (2006). Family focused grief therapy: a ran- domized, controlled trial in palliative care and bereavement. American Journal of Psychiatry, 163(7), 1208-1218. https://doi. org/10.1176/ajp.2006.163.7.1208
31. Kissane, D., Zaider, T., Li, Y., Hichenberg, S., Schuler, T., Lederberg, M., Lavelle, L., Loeb, R. and Del Gaudio, F. (2016). Randomized Controlled Trial of Family Therapy in Advanced Cancer Continued Into Bereavement. Journal of Clinical Oncology, 34(16), pp.1921-1927. https://doi.org/10.1200/jco.2015.63.0582
32. Lebel, S., Ozakinci, G., Humphris, G., Thewes, B., Prins, J., Dinkel, A., & Butow, P. (2017). Current state and future prospects of research on fear of cancer recurrence. Psycho-oncology, 26(4), 424-427. https://doi.org/10.1002/pon.4103
33. Lee, M. and Yun, Y. (2018). Family Functioning Predicts End-of-Life Care Quality in Patients With Cancer. Cancer Nursing, 41(3), pp.E1-E10. https://doi.org/10.1097/ncc.0000000000000495
34. Lewis, F. M., Loggers, E. T., Phillips, F., Palacios, R., Tercyak, K. P., Griffith, K. A., ... & Almulla, H. A. (2020). Enhancing connec- tions-palliative care: a quasi-experimental pilot feasibility study of a cancer parenting program. Journal of Palliative Medici- ne, 23(2), 211-219. https://doi.org/10.1089/jpm.2019.0163
35. Masterson, M. P., Schuler, T. A., & Kissane, D. W. (2013). Family focused grief therapy: a versatile intervention in palliative care and bereavement. Bereavement Care, 32(3), 117-123. https://doi.org/10.1080/02682621.2013.854544
36. Milberg, A., Olsson, E., Jakobsson, M., Olsson, M. and Friedrichsen, M. (2008). Family Members’ Perceived Needs for Bere- avement Follow-Up.Journal of Pain and Symptom Management, 35(1), pp.58-69. https://doi.org/10.1016/j.jpainsym- man.2007.02.039
37. Mondia, S., Hichenberg, S., Kerr, E., Eisenberg, M. and Kissane, D. (2011). The Impact of Asian American Value Systems on Palliative Care. American Journal of Hospice and Palliative Medicine®, 29(6), pp.443-448. https://doi.org/10.1177/1049909111426281
38. Morris, J., Turnbull, D., Preen, D., Zajac, I. and Martini, A. (2018). The psychological, social, and behavioural impact of a parent’s cancer on adolescent and young adult offspring aged 10–24 at time of diagnosis: A systematic review. Journal of Adolescence, 65, pp.61-71. https://doi.org/10.1016/j.adolescence.2018.03.001
39. Park, E. M., Miller, K. L., & Knafl, K. A. (2019). Understanding familial response to parental advanced cancer using the family ma- nagement style framework. Journal of psychosocial oncology, 37(6), 758-776. https://doi.org/10.1080/07347332.2019.16 14132
40. Petursdottir, A. B., & Svavarsdottir, E. K. (2019). The effectivness of a strengths-oriented therapeutic conversation interventi- on on perceived support, well-being and burden among family caregivers in palliative home-care. Journal of advanced nur- sing, 75(11), 3018-3031. https://doi.org/10.1111/jan.14089
41. Romo, R., Cenzer, I., Williams, B. and Smith, A. (2018). Relationship Between Expectation of Death and Location of De- ath Varies by Race/Ethnicity. American Journal of Hospice and Palliative Medicine®, 35(10), pp.1323-1329. https://doi. org/10.1177/1049909118773989
42. Sahare, M. and Kulkarni, D. (2020). Diagnosis ofTwo Chronic Disease: A Review. SSRN Electronic Journal. https://doi.org/10.2139/ ssrn.3646216
43. Sanagoo, A., Azizi Moghadam, A., Hazini, A., Azar Gashb, E., Mahasti Jouybari, L. and Araghian Mojarad, F. (2016). The Compari- son of Family Member’s Satisfaction of Palliative Care and Standard Care for Patients With Incurable Cancer. Journal of Critical Care Nursing. https://doi.org/10.17795/ccn-6243
44. Santesteban-Echarri, O., MacQueen, G., Goldstein, B. I., Wang, J., Kennedy, S. H., Bray, S., ... & Addington, J. (2018). Family fun- ctioning in youth at-risk for serious mental illness. Comprehensive Psychiatry, 87, 17-24. https://doi.org/10.1016/j.comppsy- ch.2018.08.01
45. Schuler, T. A., Zaider, T. I., & Kissane, D. W. (2012). Family grief therapy: A vital model in oncology, palliative care and bereave- ment. Family Matters, (90), 77-86. https://doi.org/10.1080/02682621.2013.854544
46. Schuler, T. A., Zaider, T. I., Li, Y., Hichenberg, S., Masterson, M., & Kissane, D. W. (2014). Typology of perceived family functioning in an American sample of patients with advanced cancer. Journal of pain and symptom management, 48(2), 281-288. https:// doi.org/10.1016/j. jpainsymman. 2013.09.013
47. Schuler, T. A., Zaider, T. I., Li, Y., Masterson, M., McDonnell, G. A., Hichenberg, S., ... & Kissane, D. W. (2017). Perceived family func- tioning predicts baseline psychosocial characteristics in US participants of a family focused grief therapy trial. Journal of Pain and Symptom Management, 54(1), 126-131. https://doi.org/10.1016/j.jpainsymman.2017.03.01
48. Siegel, R. L., Miller, K. D., Wagle, N. S., & Jemal, A. (2023). Cancer statistics, 2023. CA: a cancer journal for clinicians, 73(1), 17-48. https://doi.org/10.3322/caac.21763
49. Streck, B. P., Wardell, D. W., LoBiondo-Wood, G., & Beauchamp, J. E. (2020). Interdependence of physical and psychological mor- bidity among patients with cancer and family caregivers: review of the literature. Psycho-oncology, 29(6), 974-989. https:// doi.org/10.1002/pon.5382 Van Schoors, M., De Mol, J., Verhofstadt, L. L., Goubert, L., & Van Parys, H. (2020). The family practice of support-giving after a pediatric cancer diagnosis: A multi-family member interview analysis. European Journal of Oncology Nursing, 44, 101712. htt- ps://doi.org/10.1016/j.ejon.2019.101712
50. Weber, M., Alvariza, A., Kreicbergs, U. and Sveen, J. (2019). Communication in families with minor children following the loss of a parent to cancer. European Journal of Oncology Nursing, 39, pp.41-46. https://doi.org/10.1016/j.ejon.2019.01.005
51. Wiese, C., Morgenthal, H., Bartels, U., Voßen-Wellmann, A., Graf, B. and Hanekop, G. (2010). Post-mortal bereavement of family caregivers in Germany: a prospective interview-based investigation. Wiener klinische
52. Wochenschrift, 122(13-14), pp.384-389. https://doi.org/10.1007/s00508-010-1396-z World Health Organization (2017) WHO definition of palliative care. Available at: https://www.who.int/cancer/palliative/definiti- on/en/ (Erişim: 16.06.2023) World Health Organization (2018) Global Health Observatory. Available at: https://www.who.int/gho/database/en/ (Erişim: 16.06.2023)
53. Yamashita, R., Arao, H., Takao, A., Masutani, E., Morita, T., Shima, Y., Kizawa, Y., Tsuneto, S., Aoyama, M. and Miyashita, M. (2017). Unfinished Business in Families of Terminally Ill With Cancer Patients. Journal of Pain and Symptom Management, 54(6), pp.861-869. https://doi.org/10.1016/j.jpainsymman.2017.04.013
54. Zaider, T. I., Kissane, D. W., Schofield, E., Li, Y., & Masterson, M. (2020). Cancer-related communication during sessions of family therapy at the end of life. Psycho-Oncology, 29(2), 373-380. https://doi.org/10.1002/pon.5268
55. Zhang, Y. (2018). Family functioning in the context of an adult family member with illness: A concept analysis. Journal of Clinical Nursing, 27(15-16), pp.3205-3224. https://doi.org/10.1111/jocn.14500