Providing family support in palliative care

Family dynamics often change when a member of the family has advanced illness. Most families find this experience stressful, and it can either reinforce positive coping styles or accentuate interpersonal dysfunction.

To support a family, it is often helpful for healthcare professionals to seek to understand the family structure and dynamics. Consider the way they are coping and adapting to the situation and recognise that family members will have different coping styles. Acknowledge that there may be tension or conflict within a family, but be realistic about the support that can be provided and the results that can be achieved.

Support for a family is best provided with the consent of the patient to share their personal information; however, in the absence of patient consent, support of a general nature can be given, while being mindful of patient confidentiality (see Privacy and confidentiality in palliative care).

Supporting a family also includes explaining what to expect and how they can help. It is important to manage expectations; be honest and discuss the realistic options for care that may be available. Conducting a family meeting can be useful to provide information and address the family’s questions and concerns. For information on how to support the family when a patient is approaching death, see Prebereavement support for adult family members and carers and Prebereavement support for children.

Families who are experiencing significant difficulties may benefit from referral for counselling or other specialised support; contact the local specialist palliative care service for information on the services available locally.

Providing support to family members who live far from a patient can be challenging. They may join family meetings by teleconference, but it can be difficult for them to understand the full context of the patient’s situation from afar. A separate conversation (with permission from the patient) to explain the situation provides an opportunity to respond to their questions and concerns.

For a family member who has taken on the role of principal carer, ask about the emotional and physical burden of caregiving, and allow them to express the difficulties they experience in providing care. Recognise the possibility that they may feel some caregiving tasks are beyond their capacity, and let them know that it is acceptable to seek assistance. For more information, see Support for carers in palliative care.