Predicting conflict with staff among families of cancer patients during prolonged hospitalizations

Most families of cancer patients work effectively with medical staff; however, a minority of families engage in conflict with staff. This article reports attempts to predict such conflict using the Family Adaptability-Cohesion Evaluation Scale (FACES II). First, the authors developed maximally sensitive and specific criteria for predicting conflict between staff and families by retrospectively applying the FACES II to the families of 40 patients who had received treatment in leukemia and bone marrow transplantation units. Then, they examined the sensitivity and specificity of thesecriterion scores prospectively with a second sample of 40 families. An oncology fellow and a head nuTse made independent judgments concerning whether a family demonstrated any of six behaviors that would generate family-staff conflict during the patient’s hospitalization. The degree of agreement between the raters proved to be acceptable, and conflict was predicted in the prospective sample with high sensitivity and acceptable specificity. In the second group of 40 families, approximately 20 percent actually came into conflict with staff. However, an additional 20 percent would have been targeted for intervention on the basis of their scores. Whether the needs of these families are great enough to make intervention with them cost- effective requires further investigation.