The Influence of Family Communication Patterns and Young Adults Engaging in Advance Care Planning with Their Parents: A Mixed-Methods Study
Open Access
- Author:
- Murphy, Julie Lynn
- Graduate Program:
- Nursing
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 29, 2019
- Committee Members:
- Judith E Hupcey, Dissertation Advisor/Co-Advisor
Judith E Hupcey, Committee Chair/Co-Chair
Lisa Ann Kitko, Committee Member
Jacqueline Ann Mogle, Committee Member
Jon F Nussbaum, Outside Member - Keywords:
- advance care planning
nursing
communication
family communication patterns
mixed methods - Abstract:
- Purpose: This study explored the influence of family communication patterns in advance care planning discussions between young adult children and parents and the perceptions of young adult children about engaging in these conversations with their parents. Background: Advance care planning is a process designed to elicit the values and goals for medical treatment for persons as they approach the end of their life, especially if they are unable to make their own decisions. Central to advance care planning are the iterative conversations that should occur between the person, family, and health care providers. The goal of repeated advance care planning conversations is to ensure that medical decision making is congruent with an individual’s previously stated values and goals. Despite many years of research focused on this topic, no clear pathway for conducting advance care planning conversations has been established. As persons grow older, they are typically in need of medical decision making and often, their surrogate decision makers are their adult children. There is also limited research exploring young adult children and their role in advance care planning discussion with parents. Family communication patterns may influence these conversations, but this has not been explored. The family communication patterns theory undergirded this study. Within this theory four different family types were identified based on the interaction of conversation and conformity orientation. These family types may explain how families communicate and come to make decisions, however, they have not been explored in the context of advance care planning. Methods: Young adult children from one suburban university participated in this convergent parallel mixed methods study. Each participant completed the Revised Family Communication Patterns (RFCP) survey to determine family type. Focus groups were then conducted to explore self-selected family communication pattern type and perceptions of the participants about engaging in advance care planning with their parents. Focus groups continued until saturation was reached. Qualitative data were analyzed using a content analysis approach. The RFCP surveys were scored according to published guidelines and were analyzed using descriptive statistics and correlations. Data were then integrated to fully answer the research questions. Results: Participants (n=39) had RFCP results that were comparable to existing literature, conversation orientation (M=3.56, SD=0.64, and median=3.67) and conformity orientation M=2.93, SD=0.64, and median=2.91). When split at the median, it resulted in the following family communication pattern types pluralistic n=11, consensual n=9, protective n=11, and laissez-faire n=8. Qualitative analysis revealed incongruence between self-selected family types and RFCP results. In addition, many participants were unable to select a single family type, but instead identified a different communication pattern with the mother versus the father. The majority of participants stated that they were able engage in advance care planning conversations with their parents regardless of family type. However, high conversation orientation was found to be a facilitator of advance care planning conversations while high conformity orientation was a barrier to advance care planning conversations. Participants also verbalized the ability to use knowledge gained during advance care planning conversations as the basis for decision-making. Conclusions: Results show that family communication patterns may influence advance care planning conversations. However, the theory did not fully explain the family communication patterns since triadic communication patterns did not exist in all participants. Many chose a more dyadic approach describing different patterns between their parents. Implications from this research provide an improved understanding of family communication patterns, describe which characteristics of family communication may influence advance care planning conversations, and expand the Family Communication Patterns theoretical model. Young adults are poised to introduce and discuss advance care planning with their parents. Nurses are positioned to facilitate advance care planning through identification of family communication patterns, development of interventions, and improvement of education initiatives to individuals and families. Future research studies need to be conducted in larger samples to examine family communication patterns and its influence in advance care planning.