Typology of perceived family functioning in an American sample of patients with advanced cancer

J Pain Symptom Manage. 2014 Aug;48(2):281-8. doi: 10.1016/j.jpainsymman.2013.09.013. Epub 2014 Apr 22.


Context: Poor family functioning affects psychosocial adjustment and the occurrence of morbidity following bereavement in the context of a family's coping with advanced cancer. Family functioning typologies assist with targeted family-centered assessment and intervention to offset these complications in the palliative care setting.

Objectives: Our objective was to identify the number and nature of potential types in an American palliative care patient sample.

Methods: Data from patients with advanced cancer (N = 1809) screened for eligibility for a larger randomized clinical trial were used. Cluster analyses determined whether patients could be classified into clinically meaningful and coherent groups, based on similarities in their perceptions of family functioning across the cohesiveness, expressiveness, and conflict resolution subscales of the Family Relations Index.

Results: Patients' reports of perceived family functioning yielded a model containing five meaningful family types.

Conclusion: Cohesiveness, expressiveness, and conflict resolution appear to be useful dimensions by which to classify patient perceptions of family functioning. "At risk" American families may include those we have called hostile, low-communicating, and less-involved. Such families may benefit from adjuvant family-centered psychosocial services, such as family therapy.

Keywords: Family; assessment; bereavement; cancer; cluster analysis; family functioning; family therapy; grief; psychotherapy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adaptation, Psychological
  • Analysis of Variance
  • Bereavement
  • Cluster Analysis
  • Communication
  • Conflict, Psychological
  • Family Relations*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / psychology*
  • Neoplasms / therapy
  • Palliative Care / psychology
  • Randomized Controlled Trials as Topic
  • Socioeconomic Factors
  • United States