Physician Communication with Family Caregivers of Long-Term Care Residents at the End of Life Holly Biola, MD, MPH, à wz Philip D. Sloane, MD, MPH, à w Christianna S. Williams, PhD, à z Timothy P. Daaleman, DO, MPH, à w Sharon W. Williams, PhD, § and Sheryl Zimmerman, PhD à k OBJECTIVES: To assess family perceptions of communi- cation between physicians and family caregivers of indi- viduals who spent their last month of life in long-term care (LTC) and to identify associations between characteristics of the family caregiver, LTC resident, facility, and physician care with these perceptions. DESIGN: Retrospective study of family caregivers of per- sons who died in LTC. SETTING: Thirty-one nursing homes (NHs) and 94 resi- dential care/assisted living (RC/AL) facilities. PARTICIPANTS: One family caregiver for each of 440 LTC residents who died (response rate 66.0%) was inter- viewed 6 weeks to 6 months after the death. MEASUREMENTS: Demographic and facility character- istics and seven items rating the perception of family caregivers regarding physician–family caregiver communi- cation at the end of life, aggregated into a summary scale, Family Perception of Physician-Family caregiver Commu- nication (FPPFC) (Cronbach alpha 5 0.96). RESULTS: Almost half of respondents disagreed that they were kept informed (39.9%), received information about what to expect (49.8%), or understood the doctor (43.1%); the mean FPPFC score (1.73 on a scale from 0 to 3) was slightly above neutral. Linear mixed models showed that family caregivers reporting better FPPFC scores were more likely to have met the physician face to face and to have understood that death was imminent. Daughters and daughters-in-law tended to report poorer communication than other relatives, as did family caregivers of persons who died in NHs than of those who died in RC/AL facilities. CONCLUSION: Efforts to improve physician communi- cation with families of LTC residents may be promoted using face-to-face meetings between the physician and fam- ily caregivers, explanation of the patient’s prognosis, and timely conveyance of information about health status changes, especially when a patient is actively dying. J Am Geriatr Soc 55:846–856, 2007. Key words: physician communication; end-of-life care; family perceptions; nursing home; assisted living; residen- tial care P hysician communication with patients and their family caregivers is of central importance to quality end-of-life (EOL) care. 1–6 Interviews with persons nearing the EOL (and their family caregivers) in multiple healthcare settings have found physicians to be the most-frequent subject of favorable and unfavorable comments about EOL care. 1,4–7 When asked for recommendations to improve EOL care, 25% to 44% of bereaved family caregivers targeted im- provements in physician–family caregiver communica- tion. 1,7 Most prior studies of physician–family caregiver com- munication at the EOL have been conducted in hospital or hospice settings. 3,5,8–12 These studies have found that hav- ing a physician who outlined the prognosis, knew the pa- tient well, was available, appeared comfortable discussing death and dying, and empathetically listened and answered questions affected family perceptions of EOL physician– family caregiver communication. 3,5,11,12 For example, stud- ies of bereaved family caregivers in an intensive care unit setting found that their perceptions of the quality of EOL care was not associated with the degree of medical inter- vention, but that they were more satisfied if the physician spent more time listening and less time talking during fam- ily meetings. 8,13 Approximately one-quarter of U.S. deaths now occur in nursing homes (NHs) and residential care/assisted living (RC/AL) facilities, making them increasingly common set- tings for EOL care. 14–16 Prior EOL studies in NH settings have suggested that factors influencing family perceptions Related paper presentations: Sloane P, Zimmerman S, Williams C. Physician communication and involvement in end-of-life care in assisted living and nursing homes. Presented at the 57th Annual Meeting of the Gerontological Society of America, Washington, DC, November 2004. Address correspondence to Holly Biola, Veterans Administration Medical Center, GRECC (182), 508 Fulton Street, Durham, NC 27705. E-mail: holly.biola@duke.edu DOI: 10.1111/j.1532-5415.2007.01179.x From the à Cecil G. Sheps Center for Health Services Research, w Department of Family Medicine, z Department of Epidemiology, § Division of Speech and Hearing Sciences, Department of Allied Health Sciences, and k School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and z Department of Geriatrics, Duke University, Durham, North Carolina. JAGS 55:846–856, 2007 r 2007, Copyright the Authors Journal compilation r 2007, The American Geriatrics Society 0002-8614/07/$15.00