Advancing Theory of Family Conflict at the End of Life: A Hospice Case Study

Context. Although family conflict is a common occurrence for families involved in caregiving for a dying family member, it has not been examined in the hospice context. Objectives. The purpose of this study was to advance theory of family conflict at the end of life through replication and expansion of a case study involving professional perspectives in the context of a managed care program for low-income elders with advanced chronic disease in their last six months of life, by exploring the perceptions of professionals and family caregivers experiencing conflict in the hospice context. Methods. Data were gathered through in-depth interviews with 15 hospice family caregivers experiencing substantial family conflict, and focus groups with 37 professionals employed in a large multicounty and nonprofit hospice in the Midwest U. S. Dimensional analysis, a method for the generation of grounded theory, was used to refine and expand an explanatory matrix of family conflict at the end of life. Results. The initial matrix was expanded through the inclusion of eight new and two refined categories, strengthening our understanding of family conflict as a complex phenomenon influenced by salient contextual variables, conditions, and factors that may contribute to a number of negative outcomes for patients, family members, and professionals. Conclusion. The study findings are discussed in terms of implications for assessment and intervention. J Pain Symptom Manage 2012;44:655-670. (c) 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.