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Tagami K, Masukawa K, Inoue A, Morita T, Hiratsuka Y, Sato M, Kohata K, Satake N, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Appropriate referral timing to specialized palliative care service: survey of bereaved families of cancer patients who died in palliative care units. Support Care Cancer 2021; 30:931-940. [PMID: 34417885 DOI: 10.1007/s00520-021-06493-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients' and families' experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questionnaire to 999 bereaved families of cancer patients who died in 164 palliative care units (PCUs) and analyzed the first SPC referral timing and how patients evaluated it. We defined SPC as outpatient or inpatient palliative care service comprising certified palliative care physicians, advanced-practice nurses, and multidisciplinary practitioners. Finally, 51.6% (n = 515) of all responses were analyzed. The SPC referral timing was evaluated as appropriate (26.1%), late or too late (20.2%), early or too early (1.2%), or none of these (52.5%). Of these, 32.3% reported that they were referred to an SPC when diagnosed with advanced or incurable cancer or during anti-cancer treatment, and 62.6% reported they were referred after anti-cancer treatment. Patient-perceived appropriateness of SPC referral timing was associated with their good death process. After excluding "none of these" responses, a significantly higher proportion of respondents who reported being referred to SPC at diagnosis and during anti-cancer treatment evaluated the response timing as appropriate, compared to those who reported being referred after anti-cancer treatment. Appropriate timing for SPC referrals relates to quality of death; findings suggest that appropriate timing is at the time of diagnosis or during anti-cancer treatment.
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Affiliation(s)
- Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. .,Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Kento Masukawa
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Mamiko Sato
- Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Katsura Kohata
- Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Noriaki Satake
- Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Hospital, 1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yasuo Shima
- Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba, Ibaraki, 305-8558, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Kim JY, Park BK. The Most Important Aspects for a Good Death: Perspectives from Parents of Children with Cancer. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211028580. [PMID: 34218697 PMCID: PMC8261844 DOI: 10.1177/00469580211028580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A good death is an important concept in pediatric palliative care. To improve the
quality of pediatric palliative care, it is imperative to identify which domain
is most important for a good death among children with cancer and their parents.
This study aimed to (1) assess the essential domains for a good death from the
perspectives of parents whose children have cancer using the Good Death
Inventory (GDI) and (2) examine which characteristics are associated with the
perception of a good death. An anonymous cross-sectional questionnaire was
administered to 109 parents of children with cancer. Data were collected using a
validated Korean version of the GDI. Descriptive statistics,
t-test, and ANOVA were used to identify the preferred GDI
domains. Multiple linear regression analysis was performed to identify factors
associated with the GDI scores. The most essential domains for a good death
included “maintaining hope and pleasure” and “being respected as an individual.”
The factors most strongly associated with the perception of a good death were
end-of-life plan discussion with parents or others and parental agreement with
establishing a living will. Encouraging families to discuss end-of-life care and
establish a living will in advance can improve the quality of death among
children with cancer.
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Affiliation(s)
- Ji Yoon Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Bu Kyung Park
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
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Zhao J, You L, Tao H, Wong FKY. Validation of the Chinese version of the Care Evaluation Scale for measuring the quality of structure and process of end-of-life care from the perspective of bereaved family. BMC Palliat Care 2021; 20:85. [PMID: 34158033 PMCID: PMC8220706 DOI: 10.1186/s12904-021-00777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Assessing the quality of structure and process of end-of-life care can help improve outcomes. There was currently no valid tool for this purpose in Mainland China. The aim of this study is to validate the Chinese version of the Care Evaluation Scale (CES). Methods From January to December 2017, a cross-sectional online survey was conducted among bereaved family members of cancer patients from 10 medical institutes. The reliability of the CES was assessed with Cronbach’s α, and structural validity was evaluated by confirmatory factor analysis. Concurrent validity was tested by examining the correlation between the CES total score and overall satisfaction with end-of-life care, quality of dying and death, and quality of life. Results A total of 305 valid responses were analyzed. The average CES score was 70.7 ± 16.4, and the Cronbach’s α of the CES was 0.967 (range: 0.802–0.927 for the 10 domains). The fit indices for the 10-factor model of CES were good(root-mean-square error of approximation, 0.047; comparative fit index, 0.952; Tucker–Lewis index, 0.946; standardized root mean square residual, 0.053). The CES total score was highly correlated with overall satisfaction with medical care (r = 0.775, P < 0.01), and moderately correlated with patients’ quality of life (r = 0.579, P < 0.01) and quality of dying and death (r = 0.570, P < 0.01). In addition, few associations between CES total score and demographic characteristics, except for the family members’ age. Conclusions The Chinese version of the CES is a reliable and valid tool to evaluate the quality of structure and process of end-of-life care for patients with cancer from the perspective of bereaved family in Mainland China. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00777-4.
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Affiliation(s)
- Juanjuan Zhao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Hongmei Tao
- Department of Nursing, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Frances Kam Yuet Wong
- Faculty of Health & Social Sciences, School of Nursing, The Hong Kong Polytechnic University, Hunghom, Hong Kong SAR, China.
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Igarashi N, Aoyama M, Masukawa K, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Are cancer patients living alone more or less likely to achieve a good death? Two cross-sectional surveys of bereaved families. J Adv Nurs 2021; 77:3745-3758. [PMID: 34028846 DOI: 10.1111/jan.14886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/12/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
This study examined differences in sociodemographic characteristics and the achievement of a good death between cancer patients who live alone and those who do not live alone prior to death in different settings. Secondary analysis of data collected across two cross-sectional self-reported questionnaire surveys was undertaken. The participants were bereaved family members of cancer patients who had died in palliative care units (PCUs), acute hospitals or homes. We stratified the data by the place of death and examined the differences in sociodemographic characteristics to determine the relationship between cancer patients achieving a "good death" and whether they were living alone. The data were collected through 15,949 surveys. On the Good Death Inventory, significantly higher total scores emerged for cancer patients who were living alone than for those who not living alone in PCUs (effect size [ES] = 0.11, Student's t-test: p < .0001), but not in acute hospitals (ES = -0.03, p = 0.74) or home care services (ES = 0.02, p = 0.86). Cancer patients who were living alone were more likely to have been female, been older and have earned a lower annual income than those who were not living alone. Thus, among those who had received specialized palliative care, there was no difference in the quality of palliative care between cancer patients who were or were not living alone.
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Affiliation(s)
- Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tatsuya Morita
- Palliative and Supportive care Division, Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Foundation, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Nagata C, Tsutsumi M, Kiyonaga A, Nogaki H. Evaluation of a training program for community-based end-of-life care of older people toward aging in place: A mixed methods study. Nurse Educ Pract 2021; 54:103091. [PMID: 34087577 DOI: 10.1016/j.nepr.2021.103091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/17/2022]
Abstract
AIMS To evaluate a training program that supports community-based service staff in implementing aging-in-place and end-of-life care programs. BACKGROUND Globally, as the population ages, the need for end-of-life care has never been greater. Since Japan is facing the issues of a super-aged population sooner than most countries, there is a particularly urgent need to enhance end-of-life care for older people. Most Japan's older people wish to spend their final days at home, however, only 11-13% end their lives at home, while 73% die in hospitals. As part of care system, small-scale community-based service for aging-in-place established across Japan in 2006 managed locally. These are flexible services using home or facility care or both for the individual to live long term at their preferred place. We developed the end-of-life care educational training program to encourage behavioral changes in community-based service staff of various readiness levels. DESIGN Mixed methods study design. METHODS A pre-post evaluation of knowledge, confidence and attitude toward end-of-life care, combining quantitative and qualitative data from 53 community-based service staff members who participated in the training program from September 2017 to September 2019. Participants were informed of the end-of-life care process using focus group discussions about end-of-life care and completed surveys evaluating the program before, immediately following and three months after the training. We used the four-level Kirkpatrick model as the evaluation indicator. RESULTS Quantitative analysis results indicated that participants were satisfied with the training program. Their knowledge scores regarding end-of-life care significantly improved; they also experienced confidence gains and changes in attitudes, becoming more approving of end-of-life care. Qualitative data revealed details of participants' satisfaction and what was learned. Through the focus group discussions, they created action plans for implementing end-of-life care programs, which some had accomplished in their local centers by the three-month follow-up. CONCLUSIONS These results suggest that the training program is effective for promoting end-of-life care through community-based services in Japan. Conducting follow-up training could effectively strengthen participants' commitment to end-of-life care at community-based services. Use of the training program is expected to promote services to support aging-in-place.
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Affiliation(s)
- Chizuru Nagata
- Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Masae Tsutsumi
- Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Asako Kiyonaga
- Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Hiroshi Nogaki
- Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
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56
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Cultural implications for disclosure of diagnosis and prognosis toward terminally ill cancer patients in China: A literature review. Palliat Support Care 2021; 20:283-289. [PMID: 33947500 DOI: 10.1017/s1478951521000535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Health professionals in China tend to avoid open communication with terminally ill cancer patients concerning their diagnosis and prognosis. This review aims to explore Chinese cultural beliefs and attitudes concerning disclosure and death among health professionals and cancer patients in China and to investigate preferences of terminally ill cancer patients for a "good death." METHOD A narrative literature review was conducted in May 2020 on MEDLINE, EMBASE, and WEB OF SCIENCE to include all studies with clear study design which presented its own study data or referred to data within underlying studies, published between January 2000 and May 2020, having cancer patients and/or healthcare professionals as participants, conducted in Mainland China, Hong Kong, or Taiwan and containing relevant data concerning "medical disclosure" or "good death." Quality assessment of publications was conducted using the NIH and CASP checklists. RESULTS Primary database search revealed a total of 108 papers of which 9 were ultimately included. The additional hand search led to the inclusion of eight further papers. In total, there were 11 quantitative studies, 4 qualitative studies and 2 literature reviews included in this review. Our findings indicated that most terminally ill cancer patients in China want to know the truth about their diagnosis and prognosis and preferred to be informed by their doctors. Terminally ill cancer patients valued a good relationship with family and medical staff as well as being respected as an individual and wanted to be able to prepare for death. SIGNIFICANCE OF RESULTS Terminally ill cancer patients in China often have a substantial need for information about their condition while their preferences are widely consistent with those in Western societies. Training for health professionals needs to focus on communication skills in order to overcome barriers in patient interaction.
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Anzai T, Sato T, Fukumoto Y, Izumi C, Kizawa Y, Koga M, Nishimura K, Ohishi M, Sakashita A, Sakata Y, Shiga T, Takeishi Y, Yasuda S, Yamamoto K, Abe T, Akaho R, Hamatani Y, Hosoda H, Ishimori N, Kato M, Kinugasa Y, Kubozono T, Nagai T, Oishi S, Okada K, Shibata T, Suzuki A, Suzuki T, Takagi M, Takada Y, Tsuruga K, Yoshihisa A, Yumino D, Fukuda K, Kihara Y, Saito Y, Sawa Y, Tsutsui H, Kimura T. JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases. Circ J 2021; 85:695-757. [PMID: 33775980 DOI: 10.1253/circj.cj-20-1127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takuma Sato
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital
| | - Naoki Ishimori
- Department of Community Heart Failure Healthcare and Pharmacy, Hokkaido University Graduate School of Medicine
| | - Mika Kato
- Nursing Department, Hokkaido University Hospital
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shogo Oishi
- Department of Cardiovascular Medicine, Hyogo Brain and Heart Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Masahito Takagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Nursing Department, National Cerebral and Cardiovascular Center
| | | | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Chikada A, Takenouchi S, Arakawa Y, Nin K. A descriptive analysis of end-of-life discussions for high-grade glioma patients. Neurooncol Pract 2021; 8:345-354. [PMID: 34061125 DOI: 10.1093/nop/npab010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher's exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient's wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.
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Affiliation(s)
- Ai Chikada
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Takenouchi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuko Nin
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yamaguchi T, Maeda I, Hatano Y, Suh SY, Cheng SY, Kim SH, Chen PJ, Morita T, Tsuneto S, Mori M. Communication and Behavior of Palliative Care Physicians of Patients With Cancer Near End of Life in Three East Asian Countries. J Pain Symptom Manage 2021; 61:315-322.e1. [PMID: 32777459 DOI: 10.1016/j.jpainsymman.2020.07.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The characteristics of physician communication with patients at the end of life (EOL) in East Asia have not been well studied. We investigated physicians' communications with imminently dying patients with cancer and their families in palliative care units (PCUs) in Japan, South Korea, and Taiwan. METHODS This observational study included patients with cancer newly admitted and deceased during their first admission to 39 PCUs in three countries. We evaluated 1) the prevalence and timing of informing patients and families of patients' impending death and 2) the prevalence of communication to assure the families of the patient's comfort. RESULTS We analyzed 2138 patients (Japan: 1633, South Korea: 256, Taiwan: 249). Fewer Japanese (4.8%: 95% confidence interval [95% CI], 3.8%-5.9%) and South Korean (19.6%: 95% CI, 15.2%-25.0%) patients were informed of their impending death, whereas 66.4% (95% CI, 60.2%-72.1%) of Taiwanese were informed; among all three countries, ≥90% of families were informed. Although most patients in all three countries and the families in South Korea and Taiwan were informed of the impending death greater than or equal to four days before death, 62.1% (95% CI, 59.6%-64.6%) of Japanese families were informed less than or equal to three days prior. Most families in all three countries received assurance that the patient would remain comfortable (could hear until death, no distress with death rattle or respiration with mandibular movement). CONCLUSIONS Physicians in Taiwan communicated about patient's impending death most frequently, and physicians in all three countries generally provided assurance to families that the patients would remain comfortable. Further studies should explore the reasons for these differences and the effects of such communications in East Asia.
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Affiliation(s)
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Suita, Japan
| | | | - Sang-Yeon Suh
- Department of Family Medicine, Palliative Care Center, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Medicine, School of Medicine, Dongguk University, Seoul, Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sun Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Masukawa K, Sato K, Shimizu M, Morita T, Miyashita M. Cancer Care Evaluation Scale (CCES): measuring the quality of the structure and process of cancer care from the perspective of patients with cancer. Jpn J Clin Oncol 2021; 51:92-99. [PMID: 32888002 DOI: 10.1093/jjco/hyaa165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/13/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the quality of the structure and process of cancer care from the perspective of patients with cancer, we developed a Cancer Care Evaluation Scale. METHODS Two anonymous online surveys of patients with cancer in Japan were conducted using a convenience sample of 400 adult cancer outpatients. RESULTS In total, 162 patients participated in the online surveys. Factor analysis revealed that the Cancer Care Evaluation Scale had the following 12 domains: (i) relationship with physician, (ii) relationship with nurse, (iii) physical care by physician, (iv) physical care by nurse, (v) psycho-existential care, (vi) help with decision-making for patients, (vii) coordination and consistency, (viii) environment, (ix) cost, (x) availability, (xi) care for the side effects of cancer treatment by a physician, and (xii) care for the side effects of cancer treatment by a nurse. The Cancer Care Evaluation Scale was correlated with overall care satisfaction (r = 0.75), but not with the quality of life (r = 0.40). In regard to rest-retest reliability, most items showed an intraclass correlation coefficient of 0.7 or higher. CONCLUSION The validity and reliability of the Cancer Care Evaluation Scale were confirmed, suggesting that this tool is useful for evaluating the quality of cancer care from the perspective of patients with cancer.
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Affiliation(s)
- Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuki Sato
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Megumi Shimizu
- Department of Gerontological and Home Healthcare Nursing, Course of Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Development and validation of the Terminal Delirium-Related Distress Scale to assess irreversible terminal delirium. Palliat Support Care 2021; 19:287-293. [PMID: 33397541 DOI: 10.1017/s1478951520001340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is no tool to appropriately assess terminal delirium, including the natural terminal course. The objective of this study was to develop an evaluation scale to assess distress from irreversible terminal delirium and to examine the validity of the scale. METHOD Based on previous qualitative analysis and systematic literature searches, we carried out a survey regarding the views of bereaved families and developed a questionnaire. We extracted items that bereaved families regarded as important and constructed an evaluation scale of terminal delirium. Then, we applied the questionnaire in a cross-sectional questionnaire survey of bereaved relatives of cancer patients who were admitted to a hospice or a palliative care unit. RESULTS We developed the Terminal Delirium-Related Distress Scale (TDDS), a 24 item questionnaire consisting of five subscales (support for families and respect for a patient, ability to communicate, hallucinations and delusions, adequate information about the treatment of delirium, and agitation and restlessness). Two hundred and eighty-one bereaved relatives participated in the validation phase. The construct validity was shown to be good by repeated factor analysis. Convergent validity, confirmed by the correlation between the TDDS and the Care Evaluation Scale (r = 0.651, P < 0.001), was also good. The TDDS had good internal consistency (Cronbach's alpha coefficient for all 24 items = 0.84). SIGNIFICANCE OF RESULTS This study showed that the TDDS is a valid and feasible measure of irreversible terminal delirium.
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Nakazawa Y, Takeuchi E, Miyashita M, Sato K, Ogawa A, Kinoshita H, Kizawa Y, Morita T, Kato M. A Population-Based Mortality Follow-Back Survey Evaluating Good Death for Cancer and Noncancer Patients: A Randomized Feasibility Study. J Pain Symptom Manage 2021; 61:42-53.e2. [PMID: 32711121 DOI: 10.1016/j.jpainsymman.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 11/20/2022]
Abstract
CONTEXT Evaluation of end-of-life care is a key element in quality improvement, and population-based mortality follow-back designs have been used in several countries. This design was adapted to evaluate a good death in Japan. OBJECTIVES This study aimed to explain the scientific background and rationale for assessing the feasibility of a mortality follow-back survey using a randomized design. DESIGN We used a cross-sectional questionnaire survey to assess feasibility using response rate, sample representativeness, effect on response rate with two methods, and survey acceptability. SETTING/PARTICIPANTS The subjects were 4812 bereaved family members of patients who died from the major five causes of death: cancer, heart disease, cerebrovascular disease, pneumonia, or kidney failure, using mortality data. RESULTS Overall, 682 (14.2%) questionnaires could not be delivered, and 2294 (55.5%) family members agreed to participate in the survey. There was little difference in the distribution of characteristics between the study subjects and the full population, and sample representativeness was acceptable. Sending the questionnaire with a pen achieved a higher response rate than without (weighted: 48.2% vs. 40.8%; P < 0.001). In follow-up contact, there was no difference in response rate between resending the questionnaire and a reminder letter alone (weighted: 32.9% vs. 32.4%; P = 0.803). In total, 84.8% (weighted) of the participants agreed with improving quality of care through this kind of survey. CONCLUSION This study demonstrated the feasibility of conducting a population-based mortality follow-back survey using a randomized design. An attached pen with the questionnaire was effective in improving the response rate.
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Affiliation(s)
- Yoko Nakazawa
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan.
| | - Emi Takeuchi
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazuki Sato
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya Higashi-ku, Aichi, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Hiroya Kinoshita
- Department of Palliative Care, Tokatu Hospital, Nagareyama, Chiba, Japan
| | - Yoshiyuki Kizawa
- Division of Palliative Medicine, Kobe University Hospital, Kobe University School of Medicine, Chuo-ku, Kobe, Hyogo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Masashi Kato
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan
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Koyauchi T, Suzuki Y, Sato K, Hozumi H, Karayama M, Furuhashi K, Fujisawa T, Enomoto N, Nakamura Y, Inui N, Yokomura K, Imokawa S, Nakamura H, Morita T, Suda T. Quality of dying and death in patients with interstitial lung disease compared with lung cancer: an observational study. Thorax 2020; 76:248-255. [PMID: 33298580 DOI: 10.1136/thoraxjnl-2020-215917] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is limited knowledge regarding the quality of dying and death (QODD) and end-of-life interventions in patients with interstitial lung disease (ILD). Hence, differences in QODD and end-of-life interventions between patients with ILD and those with lung cancer (LC) remain poorly understood. METHODS The primary aim of this study was to explore the differences in QODD and end-of-life interventions among patients dying with ILD versus those dying with LC. We performed a mail survey to quantify the QODD of a bereaved family's perspective using the Good Death Inventory (GDI) score. Moreover, we examined the end-of-life interventions by medical chart review. RESULTS Of 361 consecutive patients analysed for end-of-life interventions, 167 patients whose bereaved families completed questionnaires were analysed for QODD. Patients with ILD had lower GDI scores for QODD than those with LC (p=0.04), particularly in domains related to 'physical and psychological distress relief' and 'prognosis awareness and participation in decision making' (p=0.02, respectively). In end-of-life interventions, patients with ILD were less likely to receive specialised palliative care services (8.5% vs 54.3%; p<0.001) and opioids (58.2% vs 73.4%; p=0.003). Additionally, lower frequencies of participation of patients with ILD in end-of-life discussion were also observed (40.8% vs 62.4%; p=0.007). CONCLUSION Patients with ILD had lower QODD and poorer access to palliative care and decision making than those with LC. Additional efforts to improve QODD in patients with ILD, particularly in symptom relief and decision-making processes, are urgently warranted.
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Affiliation(s)
- Takafumi Koyauchi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazuki Sato
- Nursing for Advanced Practice, Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Respiratory Disease Centre, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan
| | - Shiro Imokawa
- Department of Respiratory Medicine, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Exploring the components of the quality of death in Japanese emergency departments: A qualitative study. Appl Nurs Res 2020; 56:151371. [PMID: 33280790 DOI: 10.1016/j.apnr.2020.151371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/25/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The need to care for patients who die in the emergency department is increasing in Japan, and emergency nurses are required to provide end-of-life care to ensure that patients experience a good death. However, the components of the quality of death and what constitutes a good death for patients dying in the emergency department are unclear. AIM This study aimed to explore the components of the quality of death for patients who die in emergency departments of Japanese hospitals. METHODS This study employed a qualitative design. An inductive content analysis was conducted based on semi-structured interviews with 26 participants, which included 15 emergency nurses, five emergency physicians, and six bereaved families. RESULTS Seven components of quality of death were identified: (1) transition to the end-of-life phase after receiving the best treatment, (2) dying without suffering, (3) having the patient's wishes respected, (4) having a loved one nearby, (5) maintaining human dignity, (6) having no change in appearance, and (7) not making the family feel guilty. CONCLUSION These components suggested that emergency nurses should: support patients' receipt of the best treatment and foster their smooth transition to the end-of-life phase at the appropriate time, ensure that the patients in the end-of-life phase spend time with their loved ones immediately before their death, enable the maintenance of human dignity and patient identity of end-of-life patients, and make sure that the families of end-of-life patients do not feel guilt.
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Morioka S, Mori M, Suzuki T, Yokomichi M, Hamano J, Morita T. Determinants of Physicians' Attitudes Toward the Management of Infectious Diseases in Terminally Ill Patients With Cancer. J Pain Symptom Manage 2020; 60:1109-1116.e2. [PMID: 32634472 DOI: 10.1016/j.jpainsymman.2020.06.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Antimicrobials are frequently prescribed to terminally ill patients with cancer; however, physicians' practice patterns regarding antimicrobial use vary widely. This study aimed to systematically identify factors that determine physicians' attitudes toward the management of infectious diseases in terminally ill patients with cancer. METHODS A nationwide cross-sectional survey involving 600 oncologists, 600 infectious diseases physicians, 600 palliative care physicians, and 220 home care physicians was conducted between November 2017 and January 2018. The primary endpoint was physicians' attitudes toward the management of infectious diseases in terminally ill patients with cancer with a few weeks of prognosis. Physicians' beliefs regarding management of infectious diseases as well as physician-perceived "good death" were also assessed (1 = strongly disagree to 6 = strongly agree). RESULTS There were 895 (44.3%) analyzable response, and average scores of physicians' attitudes ranged between 2.69 and 4.32. In total, 241 (27%; 95% CI = 24-30) to 691 (78%; 95% CI = 75-81) respondents showed proactive attitudes toward various infectious diseases management. In linear regression analysis, determinants of proactive attitudes included the following: physicians' belief that examination and treatment will improve quality of life and prognosis and reduce suffering (β = 0.32, t = 9.99, P = 0.00); greater physician-perceived importance on receiving enough treatment (β = 0.09, t = 2.88, P = 0.00) and less importance on dying a natural death (β = -0.07, t = -2.14, P = 0.03) for a "good death"; working at a tertiary care hospital (β = 0.16, t = 4.40, P = 0.00); and not being a home care physician (β = -0.20, t = -5.51, P = 0.00) or palliative care physician (β = -0.12, t = -3.64, P = 0.00). CONCLUSIONS Physicians have divergent attitudes toward the management of infectious diseases in terminally ill patients with cancer. Reflection by physicians on their own beliefs and perceptions regarding infectious disease management and a "good death" may help provide the best end-of-life care.
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Affiliation(s)
- Shinichiro Morioka
- Disease Control and Prevention Center, National Centre for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomomi Suzuki
- Division of Palliative Medicine, Shizuoka Cancer Center, Mishima, Shizuoka, Japan
| | - Marika Yokomichi
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tatsuya Morita
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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Hasegawa T, Sekine R, Akechi T, Osaga S, Tsuji T, Okuyama T, Sakurai H, Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Rehabilitation for Cancer Patients in Inpatient Hospices/Palliative Care Units and Achievement of a Good Death: Analyses of Combined Data From Nationwide Surveys Among Bereaved Family Members. J Pain Symptom Manage 2020; 60:1163-1169. [PMID: 32615299 DOI: 10.1016/j.jpainsymman.2020.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT In end-of-life care, rehabilitation for patients with cancer is considered to be an important means for improving patients' quality of death and dying. OBJECTIVES To determine whether the provision of rehabilitation for patients with cancer in palliative care units is associated with the achievement of a good death. METHODS This study involved a cross-sectional, anonymous, and self-report questionnaire survey of families of patients with cancer who died in palliative care units in Japan. We evaluated the short version of Good Death Inventory (GDI) on a seven-point scale. A logistic regression model was used to calculate the propensity score. Covariates included in this model were survey year, patients' characteristics, and families' characteristics. The associations between rehabilitation and GDI were tested using trend tests after propensity score matching adjustment. RESULTS Of the 1965 family caregivers who received the questionnaires, available data were obtained from 1008 respondents (51.2%). Among them, 285 (28.2%) cases received rehabilitation in palliative care units. There was no difference in total GDI score between the groups with and without rehabilitation. In exploratory analyses, patients receiving rehabilitation were significantly more likely to feel maintaining hope and pleasure (mean 4.50 [SE 0.10] vs. 4.05 [0.11], respectively; effect size [ES] 0.31; P = 0.003), good relationships with medical staff (mean 5.67 [SE 0.07] vs. 5.43 [0.09], respectively; ES 0.22; P = 0.035), and being respected as an individual (mean 6.08 [SE 0.06] vs. 5.90 [0.07], respectively; ES 0.19; P = 0.049) compared with patients not receiving rehabilitation. CONCLUSION Rehabilitation in palliative care units may contribute to several domains of quality of death and dying, particularly maintaining hope and pleasure. Further research is needed to investigate whether palliative rehabilitation contributes to the achievement of a good death.
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Affiliation(s)
- Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan.
| | - Ryuichi Sekine
- Department of Pain and Palliative Care, Kameda General Hospital, Kamogawa, Chiba, Japan
| | - Tatsuo Akechi
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan; Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, Japan
| | - Satoshi Osaga
- Clinical Research Management Center, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toru Okuyama
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan; Department of Pain and Palliative Care, Kameda General Hospital, Kamogawa, Chiba, Japan
| | - Haruka Sakurai
- Division of Rehabilitation Medicine, Nagoya City University Hospital, Mizuho-ku, Nagoya, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamtsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Saikyo-ku, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Uchida M, Morita T, Akechi T, Yokomichi N, Sakashita A, Hisanaga T, Matsui T, Ogawa A, Yoshiuchi K, Iwase S. Are common delirium assessment tools appropriate for evaluating delirium at the end of life in cancer patients? Psychooncology 2020; 29:1842-1849. [PMID: 32735046 DOI: 10.1002/pon.5499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The objectives of this study are to investigate how many advanced cancer patients became unconscious or non-communicative after pharmacological treatment for delirium, and to explore whether existing delirium assessment tools can successfully evaluate its severity at the end of life. METHODS This was a secondary analysis of a registry study that examined the efficacy and safety of antipsychotics for advanced cancer patients with delirium. A total of 818 patients were recruited from 39 specialized palliative care services in Japan. The severity of delirium was measured using the Richmond Agitation-Sedation Scale-Palliative care version, the Delirium Rating Scale-Revised-98 (DRS-R-98), and the Nursing Delirium Screening Scale (Nu-DESC) on Day 3. Data from 302 patients with motor anxiety with an Agitation Distress Scale score ≥2 on Day 0 were analyzed for this study. The patients were categorized into four treatment response groups: complete response (CR: no agitation and fully communicative), partial response (PR: no/mild agitation and partially communicative), unconscious/non-communicative (UC), and no change (NC). RESULTS On Day 3, 29 (10%; 95% confidence intervals [CI], 7-13) and 2 (1%; 95% CI, 0-2) patients became unconscious and non-communicative, respectively. Forty-four patients were categorized as CR, 97 as PR, 31 as UC, and 96 as NC. The scores of the DRS-R-98 and Nu-DESC in the UC group were rated higher than patients in the NC group were. CONCLUSIONS A considerable number of cancer patients with delirium became unconscious or non-communicative. Existing delirium assessment tools may be inappropriate for measuring the severity of delirium in end-of-life.
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Affiliation(s)
- Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Division of Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Takashi Matsui
- Department of Palliative Medicine, Tochigi Cancer Center, Utsunomiya, Japan
| | - Asao Ogawa
- Department of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Irima-gun, Japan
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Fujimori M, Sato A, Jinno S, Okusaka T, Yamaguchi T, Ikeda M, Ueno M, Ozaka M, Takayama Y, Miyaji T, Majima Y, Uchitomi Y. Integrated communication support program for oncologists, caregivers and patients with rapidly progressing advanced cancer to promote patient-centered communication: J-SUPPORT 1904 study protocol for a randomised controlled trial. BMJ Open 2020; 10:e036745. [PMID: 32967874 PMCID: PMC7513597 DOI: 10.1136/bmjopen-2019-036745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Communication is an essential aspect of care for patients with progressive serious illnesses. This study aims to evaluate the efficacy of a new, integrated communication support program for oncologists, patients with rapidly progressing advanced cancer and their caregivers. METHODS AND ANALYSIS The proposed integrated communication support programme is in the randomised control trial stage. It comprises a cluster of oncologists from comprehensive cancer centre hospitals in a metropolitan area in Japan. A total of 20 oncologists, 200 patients with advanced pancreatic cancer and the patients' caregivers are enrolled in this study as of the writing of this protocol report. Oncologists are randomly assigned to the intervention group (IG) or control group (CG). Patients and caregivers are allocated to the same group as their oncologists. The IG oncologists receive a 2.5-hour individual communication skills training, and patients and caregivers receive a half-hour coaching intervention to facilitate prioritising and discussing questions and concerns; the CG participants do not receive any training. Follow-up data will be collected quarterly for 6 months for a year and then annually for up to 3 years. The primary endpoint is the intergroup difference between before-intervention and after-intervention patient-centred communication behaviours during oncology visits. ETHICS AND DISSEMINATION This study is conducted in accordance with the ethical guidelines for clinical studies published by Japan's Ministry of Education, Cultural, Sports, Science and Technology, the Ministry of Health, Labour and Welfare, and the ethical principles established for research on humans stipulated in the Declaration of Helsinki and further amendments thereto. The protocol was approved by the Institutional Review Board of National Cancer Center, Japan on 4 July 2018 (ID: 2017-474). TRIAL STATUS This study is currently enrolling participants. Enrolment period ends 31 July 2020; estimated follow-up date is 31 March 2023. TRIAL REGISTRATION NUMBER UMIN Clinical Trial Registry (UMIN000033612); pre-results.
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Affiliation(s)
- Maiko Fujimori
- Division of Behavioral Science and Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Ayako Sato
- Division of Behavioral Science and Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Sayaka Jinno
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
| | - Takuji Okusaka
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Chuo-ku, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine Department of Medical Biochemistry, Sendai, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary Pancreatic Oncology, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan
| | - Masato Ozaka
- Department of Hepatobiliary and Pancreatic Medical Oncology, Public Interest Incorporated Foundation Cancer Institute Hospital of JFCR, Koto-ku, Japan
| | - Yukiko Takayama
- Department of Medicine, Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Shinjuku-ku, Japan
| | - Tempei Miyaji
- Department of Clinical Trial Data Management, Tokyo University Graduate School of Medicine, Bunkyo-ku, Japan
| | | | - Yosuke Uchitomi
- Division of Behavioral Science and Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Chuo-ku, Japan
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Hamano J, Morita T, Igarashi N, Shima Y, Miyashita M. The association of family functioning and psychological distress in the bereaved families of patients with advanced cancer: a nationwide survey of bereaved family members. Psychooncology 2020; 30:74-83. [PMID: 32881126 DOI: 10.1002/pon.5539] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/31/2020] [Accepted: 08/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Family conflict and family functioning were regarded as changeable factors associated with complicated grief (CG) and major depressive disorder (MDD) in the bereaved families of patients with advanced cancer, although the evidence is limited. We explored the family functioning associated with CG and MDD developing either independently or co-morbidly in the bereaved families of patients with advanced cancer who died in palliative care units (PCUs). METHODS This study comprised a nationwide cross-sectional questionnaire survey of bereaved family members of cancer patients who died in Japanese PCUs participating in evaluation of the quality of end-of-life care. RESULTS A total of 529 questionnaires (69.2%) were returned, and we analyzed a total of 458 responses. A total of 14.2% of participants were considered as having CG, 22.5% as having moderate to severe depression, and 9.6% as having co-morbid symptoms. Multivariate logistic regression analysis revealed that many family members insulted or yelled at one another (odd ratio [OR]: 2.99, p = 0.046; OR:2.57, p = 0.033), and conflict regarding what is meant by a good death (OR:3.60, p = 0.026; OR:4.06, p = 0.004) was significantly positively associated with CG, MDD, and co-morbid symptom. CONCLUSIONS Specific family conflicts may increase the incidence of CG, MDD, and co-morbid symptoms in the bereaved families of patients with advanced cancer. Our results may encourage health care providers to approach discussions about end-of-life issue with the patient and their family in advance, especially focusing on what is considered a good death for the patient, which may prevent or resolve the family conflict.
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Affiliation(s)
- Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tatsuya Morita
- Palliative Care Team, Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamtsu, Shizuoka, Japan
| | - Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasuo Shima
- Hospice Palliative Care Japan, Ashigarakami, Kanagawa, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Smith CF, Alderton DL, Clifford KM, Wells G. A Good Death - Can the Concept Be Applied to Anatomy? ANATOMICAL SCIENCES EDUCATION 2020; 13:657-663. [PMID: 32364328 DOI: 10.1002/ase.1969] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
The importance of patient-centered decisions is embedded throughout clinical practice. The principle that the patient is at the center of all decisions has helped form the contemporary approach to death and dying. The concept of a "good death" will naturally mean different things to different individuals, but is based on the foundation of being pain free, comfortable, and able to make informed decisions. Potential donors are faced with many personal, ethical, and often spiritual considerations when they come to think about their wishes after death. One consideration is that of a "good death." This article explores how the concept of a "good death" may be applied to anatomy. Where first-person consent is in place, the motivating factors frequently include the wish for others to learn from the donation, and this notion may form part of the "good death" for the donor. Such motivations may impact positively on how students feel about dissecting and may provide comfort, assuaging feelings of discomfort, and allowing students to focus on anatomical learning. For donors where second-person consent is in place, the concept of a "good death" must depend on whether the individual wanted to donate their body in the first instance. The notion of a "bad death" may also be considered with body donation where no consent for donation is in place. This article proposes that there is ultimately a place for the concept that a "good death" may involve an individual donating their body to medical education.
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Affiliation(s)
- Claire F Smith
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Dasha L Alderton
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Katie M Clifford
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Geoffrey Wells
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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71
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Katsuki M, Nakamata M, Ezaki A, Yamanaka S, Imamura S, Honda C, Kubota T, Moriuchi H, Irikura M. Survey of satisfaction regarding palliative care provided to patients who died at home or in a hospital. Int J Palliat Nurs 2020; 26:272-277. [PMID: 32841077 DOI: 10.12968/ijpn.2020.26.6.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Improvement in quality of life (QoL) of patients is one of the most important goals of palliative care, but evaluation of QoL of patients is difficult. AIM To evaluate QoL of patients who died at home or in a hospital. METHODS We administered the Good Death Inventory (10 core and 8 optional domains) to the bereaved families of patients who died at home or in a hospital. A total of 107 bereaved families undertook a survey. FINDINGS If a bereaved family chose 'somewhat agree', 'agree' or 'absolutely agree', the answer was regarded as a 'satisfactory answer'. Regarding the 10 core domains, of patients who died in a hospital, <50% respondents gave a 'satisfactory answer' to three questions, whereas of patients who died at home, >60% of respondents gave a 'satisfactory answer' to seven questions. Regarding the eight optional domains, of patients who died in a hospital, <50% respondents gave a 'satisfactory answer' to five questions, whereas of patients who died at home, >60% of respondents gave a 'satisfactory answer' to four questions. CONCLUSIONS QoL of patients who died at home appeared higher than that of those who died in a hospital. Patients prefer to remain at home rather than in a hospital, probably because at home they are surrounded by familiar things and can live according to their usual habits.
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Affiliation(s)
- Masaaki Katsuki
- Lecturer in Pharmacy, Centre of Pharmaceutical Care for Community Health, Daiichi University of Pharmacy, Japan
| | - Momoka Nakamata
- Pharmacist, Laboratory of Evidence-Based Pharmacotherapy, Daiichi University of Pharmacy, Japan
| | - Arisa Ezaki
- Pharmacist, Laboratory of Evidence-Based Pharmacotherapy, Daiichi University of Pharmacy, Japan
| | - Sayaka Yamanaka
- Pharmacist, Laboratory of Evidence-Based Pharmacotherapy, Daiichi University of Pharmacy, Japan
| | - Sakiko Imamura
- Pharmacist, Laboratory of Evidence-Based Pharmacotherapy, Daiichi University of Pharmacy, Japan
| | - Chika Honda
- Pharmacist, Laboratory of Evidence-Based Pharmacotherapy, Daiichi University of Pharmacy, Japan
| | - Toshio Kubota
- Professor of Pharmacy, Centre of Pharmaceutical Care for Community Health, Daiichi University of Pharmacy, Japan
| | - Hiroshi Moriuchi
- Professor of Pharmacy, Centre of Pharmaceutical Care for Community Health, Daiichi University of Pharmacy, Japan
| | - Mitsuru Irikura
- Professor of Pharmacy, Laboratory of Evidence-Based Pharmacotherapy, Daiichi University of Pharmacy, Japan
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72
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Gurdogan EP, Aksoy B, Kinici E. The Concept of a Good Death From the Perspectives of Family Caregivers of Advanced Cancer Patients. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:303-316. [PMID: 32703073 DOI: 10.1177/0030222820945082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to examine the importance of the concept of a good death and the contributing factors from the perspectives of family caregivers of advanced cancer patients. This descriptive and cross-sectional study, conducted with 182 family caregivers, were collected using a questionnaire form and the "Good Death Scale". The number and percentage distribution, multiple linear regression were used evaluation of data. The total score of the Good Death Scale was 62.65 ± 4.60. The factors contributing to the importance of the concept of a good death were determined as the presence of chronic disease; the type of treatment given to the patient; the presence of another family member who was previously diagnosed with cancer; the presence of a family member who has died of cancer and previously caregiving to a terminally ill family member. This study revealed that the concept of a good death is seen as very important.
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Affiliation(s)
- Eylem Pasli Gurdogan
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Berna Aksoy
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Ezgi Kinici
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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Mori M, Morita T, Imai K, Yokomichi N, Yamaguchi T, Masukawa K, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. The Bereaved Families' Preferences for Individualized Goals of Care for Terminal Dyspnea: What Is an Acceptable Balance between Dyspnea Intensity and Communication Capacity? Palliat Med Rep 2020; 1:42-49. [PMID: 34223455 PMCID: PMC8241337 DOI: 10.1089/pmr.2020.0035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Toward the individualized care of terminally ill patients with dyspnea (“terminal dyspnea”), it is essential to identify individualized goals of care (GOC) to achieve an acceptable balance between dyspnea intensity and communication capacity. Objective: To explore preferences for individualized GOC for terminal dyspnea, and factors associated with the preferences. Design: A nationwide cross-sectional survey. Setting/Subjects: In total, 1055 bereaved families of cancer patients admitted to 167 inpatient hospices in Japan. Measurements: Preferences for individualized GOC for terminal dyspnea to achieve an acceptable balance between dyspnea intensity and communication capacity, should individuals experience continuous moderate or severe/overwhelming dyspnea despite optimal palliative care, and perceptions about a good death. Results: Among 548 participants (response rate = 52%), we analyzed responses of 477 families whose loved one suffered dyspnea in the last week of life. In total, 167 (45%; 95% confidence interval [CI] = 40%–50%) and 272 (80%; 95% CI = 75%–84%) participants would prioritize dyspnea relief over communication capacity, should they continuously suffer moderate or severe/overwhelming dyspnea, respectively. In multivariate analyses, the determinants of the prioritization of dyspnea relief were perceiving physical comfort as important for a good death (odds ratio [OR] = 1.389; 95% CI = 1.062–1.818; p = 0.017) in moderate dyspnea, and perceiving physical comfort (OR = 2.505; 95% CI = 1.718–3.651; p < 0.001) and not perceiving mental awareness (OR = 0.695; 95% CI = 0.529–0.913; p = 0.009) as important in severe/overwhelming dyspnea. Conclusions: Preferences for individualized GOC for terminal dyspnea can vary among individuals and with different symptom intensity, and may be influenced by perceptions about a good death. Outcome measurements incorporating an acceptable balance between dyspnea intensity and communication capacity should be developed.
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Affiliation(s)
- Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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74
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Mizuno A, Miyashita M, Kohno T, Tokuda Y, Fujimoto S, Nakamura M, Takayama M, Niwa K, Fukuda T, Ishimatsu S, Kinoshita S, Oishi S, Mochizuki H, Utsunomiya A, Takada Y, Ochiai R, Mochizuki T, Nagao K, Yoshida S, Hayashi A, Sekine R, Anzai T. Quality indicators of palliative care for acute cardiovascular diseases. J Cardiol 2020; 76:177-183. [PMID: 32199753 DOI: 10.1016/j.jjcc.2020.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. METHODS We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. RESULTS Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". CONCLUSION In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.
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Affiliation(s)
- Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Internal Medicine, University of Pennsylvania, Philadelphia, United States.
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Shuhei Fujimoto
- Department of Health Informatics, Graduate School of Public Health, Kyoto University, Kyoto, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Terunobu Fukuda
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Shinichi Ishimatsu
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Satomi Kinoshita
- Department of Nursing, Faculty of Health & Social Work, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Shogo Oishi
- Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan
| | - Hiroki Mochizuki
- National Cerebral and Cardiovascular Center, Department of Cardiology, Suita, Osaka, Japan
| | - Akemi Utsunomiya
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuko Takada
- Department of Nursing, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University, Yokohama, Japan
| | - Toshiaki Mochizuki
- Department of Emergency Medicine, Cancer Institute Hospital, Tokyo, Japan
| | - Ken Nagao
- Cardiovascular Centre, Nihon University Hospital, Tokyo, Japan
| | - Saran Yoshida
- Graduate School of Education, Tohoku University, Miyagi, Japan
| | - Akitoshi Hayashi
- Department of Palliative Care, St. Luke's International Hospital, Tokyo, Japan
| | - Ryuichi Sekine
- Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Hirooka K, Nakanishi M, Fukahori H, Nishida A. Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users. Geriatr Gerontol Int 2020; 20:354-359. [DOI: 10.1111/ggi.13860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kayo Hirooka
- Graduate School of Health ManagementKeio University Kanagawa Japan
| | - Miharu Nakanishi
- Mental Health and Nursing Research TeamTokyo Metropolitan Institute of Medical Science Tokyo Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical CareKeio University Kanagawa Japan
| | - Atsushi Nishida
- Mental Health Promotion ProjectTokyo Metropolitan Institute of Medical Science Tokyo Japan
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76
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Stephens SJ, Chino F, Williamson H, Niedzwiecki D, Chino J, Mowery YM. Evaluating for disparities in place of death for head and neck cancer patients in the United States utilizing the CDC WONDER database. Oral Oncol 2020; 102:104555. [PMID: 32006782 DOI: 10.1016/j.oraloncology.2019.104555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate trends in place of death for patients with head and neck cancers (HNC) in the U.S. from 1999 to 2017 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. MATERIALS/METHODS Using patient-level data from 2015 and aggregate data from 1999 to 2017, multivariable logistic regression analyses (MLR) were performed to evaluate for disparities in place of death. RESULTS We obtained aggregate data for 101,963 people who died of HNC between 1999 and 2017 (25.9% oral cavity, 24.6% oropharynx/pharynx, 0.4% nasopharynx, and 49.1% larynx/hypopharynx). Most were Caucasian (92.7%) and male (87.0%). Deaths at home or hospice increased over the study period (R2 = 0.96, p < 0.05) from 29.2% in 1999 to 61.2% in 2017. On MLR of patient-level data from 2015, those who were single (ref), ages 85+ (OR 0.78; 95% CI: 0.68, 0.90), African American (OR 0.73; 95% CI: 0.65, 0.82), or Asian/Pacific Islanders (OR 0.66; 95% CI: 0.54, 0.81) were less likely to die at home or hospice. On MLR of the aggregate data (1999-2017), those who were female (OR 0.87; 95% CI: 0.83, 0.91) or ages 75-84 (OR 0.79; 95% CI: 0.76, 0.82) were also less likely to die at home or hospice. In both analyses, those who died from larynx/hypopharynx cancers were less likely to die at home or hospice. CONCLUSIONS HNC-related deaths at home or hospice increased between 1999 and 2017. Those who were single, female, African American, Asian/Pacific Islander, older (ages 75+), or those with larynx/hypopharynx cancers were less likely to die at home or hospice.
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Affiliation(s)
- Sarah J Stephens
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Hannah Williamson
- Biostatistics Shared Resource, Duke Cancer Institute, DUMC Box 2717, Durham, NC 27710, USA.
| | - Donna Niedzwiecki
- Biostatistics Shared Resource, Duke Cancer Institute, DUMC Box 2717, Durham, NC 27710, USA.
| | - Junzo Chino
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | - Yvonne M Mowery
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
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Nagoya Y, Miyashita M, Irie W, Yotani N, Shiwaku H. Development of a Proxy Quality-of-Life Rating Scale for the End-of-Life Care of Pediatric Cancer Patients Evaluated from a Nurse's Perspective. J Palliat Med 2020; 23:82-89. [DOI: 10.1089/jpm.2018.0598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuko Nagoya
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
- Miyagi Children's Hospital, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Miyagi, Japan
| | - Wataru Irie
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
| | - Nobuyuki Yotani
- Division of Palliative Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hitoshi Shiwaku
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
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Yang H, Lu Y, Hou X, Guo R, Wang Y, Liu L, Gu Y, Sun H. Nurse‐rated good death of Chinese terminally ill patients with cancer: A cross‐sectional study. Eur J Cancer Care (Engl) 2019; 28:e13147. [PMID: 31433538 DOI: 10.1111/ecc.13147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/07/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Hong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Nursing Department Peking University Cancer Hospital & Institute Beijing China
| | - Yuhan Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Nursing Department Peking University Cancer Hospital & Institute Beijing China
| | - Xiaoting Hou
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Oncology Peking University Cancer Hospital & Institute Beijing China
| | - Renxiu Guo
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology Peking University Cancer Hospital & Institute Beijing China
| | - Yun Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Integrative Medicine and Geriatric Oncology Peking University Cancer Hospital & Institute Beijing China
| | - Li Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Nursing Department Peking University Cancer Hospital & Institute Beijing China
| | - Yirong Gu
- Nursing Department Beijing Shijitan Hospital of Capital Medical University Beijing China
| | - Hongyu Sun
- Humanities Teaching and Research Section, School of Nursing Peking University Beijing China
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79
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Dong T, Zhu Z, Guo M, Du P, Wu B. Association between Dying Experience and Place of Death: Urban–Rural Differences among Older Chinese Adults. J Palliat Med 2019; 22:1386-1393. [DOI: 10.1089/jpm.2018.0583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tingyue Dong
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
| | - Mengdi Guo
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Peng Du
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, New York
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80
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Zhao J, Wong FKY, You L, Tao H. Validation of the Chinese Version of the Good Death Inventory for Evaluating End-of-Life Care From the Perspective of the Bereaved Family. J Pain Symptom Manage 2019; 58:472-480. [PMID: 31173872 DOI: 10.1016/j.jpainsymman.2019.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 12/29/2022]
Abstract
CONTEXT It is essential to evaluate good death of patients with cancer. However, currently, there is no validated measurement tool available in Mainland China. OBJECTIVES To validate the Chinese version of the Good Death Inventory (GDI). METHODS An online survey was distributed to the bereaved family members of patients with cancer (from 10 medical institutes) who died between January 2014 and December 2016. The survey included the demographic characteristics of the patients and their family members, the Chinese version of the GDI, overall satisfaction of family members regarding the end-of-life care, as well as the patients' overall quality of death and dying, and overall quality of life. RESULTS A total of 305 valid responses were analyzed. The average score of the GDI was 241.20 ± 39.45. The Cronbach's α coefficient of the GDI was 0.896 overall and ranged from 0.561 to 0.950 for the subdomains. The fit indices for the original 18-factor model were acceptable: root mean square error of approximation = 0.044, Comparative Fit Index = 0.900, Tucker-Lewis Index = 0.892, and standardized root mean square residual = 0.073. The total scores of the GDI were moderately correlated with overall satisfaction with medical care (r = 0.411, P < 0.01), patient's quality of life (r = 0.468, P < 0.01), and quality of death and dying (r = 0.441, P < 0.01). CONCLUSIONS The psychometric characteristics of the Chinese version of the GDI indicate that this questionnaire is reliable and valid. It can be used as a tool for the assessment of quality of death and dying of patients with cancer among the Chinese population.
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Affiliation(s)
- Juanjuan Zhao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | | | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Hongmei Tao
- Department of Nursing, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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81
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Alyami HM, Chan RJ, New K. End-of-life care preferences for people with advanced cancer and their families in intensive care units: a systematic review. Support Care Cancer 2019; 27:3233-3244. [PMID: 31102056 DOI: 10.1007/s00520-019-04844-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Advanced cancer patients' end-of-life care preferences in oncology units, medical-surgical units, nursing homes and palliative care services have been established. However, less is known about end-of-life care preferences of patients with advanced cancer in intensive care units and their families. AIM To explore end-of-life care preferences of patients with advanced cancer and their families in intensive care units and if these align with essential elements for end-of-life care. DESIGN Electronic databases were searched up to February 2018. Reference lists of retrieved articles were screened for potential studies. RESULTS A total of 112 full text articles were retrieved. Of these, 12 articles reporting outcomes from 10 studies were eligible for inclusion. The majority were retrospective chart reviews (n = 7) and conducted in developed countries (n = 9). Care preferences change over time with deteriorating physical condition. Ongoing patient-centred communication and shared decision-making are critical as is teamwork and involvement of a palliative care team. Marital status, gender and ethnicity appear to influence care preferences. Of those studies examining patient preferences and/or the receiving of their preferences, these could be aligned with approximately half of the Australian essential elements for end-of-life care. CONCLUSIONS Providing end-of-life care for patients with advanced cancer in intensive care units is challenging. No studies have investigated prospectively the end-of-life care preferences of patients and their families in this acute setting. Further research is required to determine the elements of care preferences for patients with advanced cancer and their families in intensive care units in developing countries.
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Affiliation(s)
- Hanan M Alyami
- School of Nursing, Midwifery and Social Work, Chamberlain Building St. Lucia Campus, University of Queensland, Brisbane, QLD, 4072, Australia.
- College of Nursing, Princess Nourah bint Abdulrahman University, PO Box 84428, Riyadh, Saudi Arabia.
| | - Raymond Javan Chan
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
- Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Karen New
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, 4072, Australia
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Kanda K, Takashima N, Tsuji Y, Yokoyama K, Hirao T. Quality of dying and death desired by residents of Kagawa Prefecture, Japan: a qualitative study. Environ Health Prev Med 2019; 24:51. [PMID: 31366323 PMCID: PMC6670115 DOI: 10.1186/s12199-019-0806-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/22/2019] [Indexed: 11/17/2022] Open
Abstract
Background Achieving a desirable death is an urgent aging-related problem in Japan. However, measures of the quality of death and dying in Japan are lacking. This study aimed to identify components of a desirable death in the residents of Kagawa prefecture, Japan, through focus group interviews. Methods A group interview was conducted with 30 residents aged 20–80 (Mage = 50.9, SD = 22.1 years; 43.3% ≥ 65 years; 40.0% unemployed) who had experienced the death of a closely associated person. Participants were grouped into four generations with diverse characteristics (e.g., age, sex, occupation). The interview lasted 1–2 h and involved one interviewer, one observer, and one recorder. The interview theme was “What is a desirable death?” Participants were asked “What do you want to achieve before you die?” or “What would a close friend want to experience when death is near?” We then extracted important items related to “desirable death” using serialization and observation records, while also consulting three analysts. The analysis results of the four generations were ultimately integrated into final categories. Results The most common experience of a familiar death was that of parents, followed by grandparents. Half of participants had witnessed the death. Through category analysis, eight important categories related to desirable death were ultimately extracted. Nine items were identified as common to all generations. While the elderly generation had wide-ranging opinions, the younger generations’ opinions tended to concentrate on satisfaction with life and family relations. Conclusion Eight concepts were extracted as important factors of a desirable death from the residents of Kagawa prefecture, Japan.
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Affiliation(s)
- Kanae Kanda
- Department of Public Health, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho Kita-gun, Kagawa, 761-0793, Japan.
| | - Nobuko Takashima
- Department of Nursing, Faculty of Health Sciences, Kagawa Prefectural University of Health Sciences, Kagawa, Japan
| | - Yoshimi Tsuji
- Department of Nursing, Faculty of Health Sciences, Kagawa Prefectural University of Health Sciences, Kagawa, Japan
| | - Katsunori Yokoyama
- Division of Health and Welfare Administration, Department of Health and Welfare, Kagawa Prefectural Office, Kagawa, Japan
| | - Tomohiro Hirao
- Department of Public Health, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho Kita-gun, Kagawa, 761-0793, Japan
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Tools Measuring Quality of Death, Dying, and Care, Completed after Death: Systematic Review of Psychometric Properties. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:183-197. [PMID: 30141020 PMCID: PMC6397142 DOI: 10.1007/s40271-018-0328-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Measuring the quality of care at the end of life and/or the quality of dying and death can be challenging. Some measurement tools seek to assess the quality of care immediately prior to death; others retrospectively assess, following death, the quality of end-of-life care. The comparative evaluation of the properties and application of the various instruments has been limited. Objective This systematic review identified and critically appraised the psychometric properties and applicability of tools used after death. Method We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by systematically searching MEDLINE, Embase, CINAHL, and PsycINFO for relevant studies. We then appraised the psychometric properties and the quality of reporting of the psychometric properties of the identified tools using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist. The protocol of this systematic review has been registered on PROSPERO (CRD42016047296). Results The search identified 4751 studies. Of these, 33 met the inclusion criteria, reporting on the psychometric properties of 67 tools. These tools measured quality of care at the end of life (n = 35), quality of dying and death (n = 22), or both quality of care at the end of life and dying and death (n = 10). Most tools were completed by family carers (n = 57), with some also completed by healthcare professionals (HCPs) (n = 2) or just HCPs (n = 8). No single tool was found to be adequate across all the psychometric properties assessed. Two quality of care at the end of life tools—Care of the Dying Evaluation and Satisfaction with Care at the End of Life in Dementia—had strong psychometric properties in most respects. Two tools assessing quality of dying and death—the Quality of Dying and Death and the newly developed Staff Perception of End of Life Experience—had limited to moderate evidence of good psychometric properties. Two tools assessing both quality of care and quality of dying and death—the Quality Of Dying in Long-Term Care for cognitively intact populations and Good Death Inventory (Korean version)—had the best psychometric properties. Conclusion Four tools demonstrated some promise, but no single tool was consistent across all psychometric properties assessed. All tools identified would benefit from further psychometric testing. Electronic supplementary material The online version of this article (10.1007/s40271-018-0328-2) contains supplementary material, which is available to authorized users.
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Mori M, Fujimori M, van Vliet LM, Yamaguchi T, Shimizu C, Kinoshita T, Morishita-Kawahara M, Inoue A, Inoguchi H, Matsuoka Y, Bruera E, Morita T, Uchitomi Y. Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video-vignette study (J-SUPPORT1601). Cancer 2019; 125:3320-3329. [PMID: 31206639 DOI: 10.1002/cncr.32327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/31/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nondisclosure of a poor prognosis to patients with advanced cancer remains a typical practice in Asia. Although the importance of prognostic communication has increasingly been recognized worldwide, little is known about whether explicit prognostic disclosure positively affects Asian patients with advanced cancer. The objective of this study was to examine the effects of explicit prognostic communication on patients with cancer recurrence. METHODS In this randomized, video-vignette study, Japanese women with breast cancer who had undergone curative surgery viewed videos of prognostic communication between a patient with recurrent, incurable breast cancer and her oncologist. The videos differed only in the presence or absence of explicit prognostic disclosure. The primary outcome was participants' uncertainty (rated from 0 to 10), and the secondary outcomes included anxiety (measured on the State-Trait Anxiety Inventory-State: range, 20-80), satisfaction (Patient Satisfaction Questionnaire; range 0-10), self-efficacy (range, 0-10), and willingness to discuss advance care planning (range, 1-4). RESULTS In total, 105 women participated (mean ± SD age, 53.8 ± 8.2 years). After viewing the video with more versus less explicit disclosure, participants showed significantly lower uncertainty (mean ± SE scores, 5.3 ±0.2 vs 5.7 ± 0.2, respectively; P = .032) and higher satisfaction (5.6 ± 0.2 vs 5.2 ± 0.2, respectively; P = .010) without increasing anxiety (changes in scores on the State-Trait Anxiety Inventory-State: 0.06 ± 0.5 vs 0.6 ± 0.5, respectively; P = .198). No significant differences were observed in self-efficacy (5.2 ± 0.2 vs 5.0 ± 0.2, respectively; P = .277) or willingness to discuss advance care planning (2.7 ± 0.1 vs 2.7 ± 0.1, respectively; P = .240). CONCLUSIONS Explicit prognostic disclosure prompted better outcomes than nondisclosure in Japanese women with breast cancer. When asked about the prognosis by Asian patients with cancer, clinicians may be encouraged to respect their wishes and explicitly discuss the prognosis if deemed appropriate.
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Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan.,Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Maiko Fujimori
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Liesbeth M van Vliet
- Department of Communication, Nivel-Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of Health, Medical, and Neuropsychology, Leiden University, Leiden, Netherlands
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chikako Shimizu
- Department of Breast Medical Oncology, National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Miki Morishita-Kawahara
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Hironobu Inoguchi
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Matsuoka
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yosuke Uchitomi
- Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Innovation Center for Supportive, Palliative, and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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85
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Gijsberts MJHE, van der Steen JT, Hertogh CMPM, Deliens L. Spiritual care provided by nursing home physicians: a nationwide survey. BMJ Support Palliat Care 2019; 10:e42. [PMID: 30948448 PMCID: PMC7691803 DOI: 10.1136/bmjspcare-2018-001756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/03/2019] [Accepted: 03/13/2019] [Indexed: 11/04/2022]
Abstract
Objective To examine perceptions and experiences regarding providing spiritual care at the end of life of elderly care physicians practising in nursing homes in the Netherlands, and factors associated with spiritual care provision. Methods A cross-sectional survey was sent to a representative sample of 642 elderly care physicians requesting information about their last patient who died and the spiritual care they provided. We compared their general perception of spiritual care with spiritual and other items abstracted from the literature and variables associated with the physicians’ provision of spiritual care. Self-reported reasons for providing spiritual care were analysed with qualitative content analysis. Results The response rate was 47.2%. Almost half (48.4%) provided spiritual end-of-life care to the last resident they cared for. Half (51.8%) identified all 15 spiritual items, but 95.4% also included psychosocial items in their perception of spirituality and 49.1% included other items. Physicians who included more non-spiritual items reported more often that they provided spiritual care, as did more religious physicians and those with additional training in palliative care. Reasons for providing spiritual care included a request by the resident or the relatives, resident’s religiousness, fear of dying and involvement of a healthcare chaplain. Conclusion Most physicians perceived spirituality as a broad concept and this increased self-reported spiritual caregiving. Religious physicians and those trained in palliative care may experience fewer barriers to providing spiritual care. Additional training in reflecting upon the physician’s own perception of spirituality and training in multidisciplinary spiritual caregiving may contribute to the quality of end-of-life care for nursing home residents.
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Affiliation(s)
- Marie-José H E Gijsberts
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Jenny T van der Steen
- Public Health and Primary Care, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Cees M P M Hertogh
- General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Luc Deliens
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Medical Oncology, Ghent University Hospital, Ghent, Belgium
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Mataqi M, Aslanpour Z. Factors influencing palliative care in advanced dementia: a systematic review. BMJ Support Palliat Care 2019; 10:145-156. [DOI: 10.1136/bmjspcare-2018-001692] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/23/2019] [Accepted: 03/06/2019] [Indexed: 12/31/2022]
Abstract
BackgroundDementia is a progressive neurodegenerative life-limiting disease. The international literature indicates that patients with advanced dementia can benefit from palliative care (PC) provided during the end-of-life phase. However, evidence indicates that currently many fail to access such provision despite the increased recognition of their palliative needs.AimTo investigate the factors influencing provision of PC services for people with advanced dementia.MethodsA systematic review of mixed method studies written in English was undertaken. 11 electronic databases including Embase, Medline, PubMed, CINAHL and Scopus from 2008 to 2018 were searched. Narrative synthesis and content analysis were used to analyse and synthesise the data.Key findingsIn total, 34 studies were included. 25 studies providing qualitative data, 6 providing quantitative data and 3 mixed methods studies. The findings identified organisational, healthcare professionals and patients-related barriers and facilitators in provision of PC for people with advanced dementia from perspective of stakeholders across different care settings. The most commonly reported barriers are lack of skills and training opportunities of the staff specific to PC in dementia, lack of awareness that dementia is a terminal illness and a palliative condition, pain and symptoms assessment/management difficulties, discontinuity of care for patients with dementia and lack of coordination across care settings, difficulty communicating with the patient and the lack of advance care planning.ConclusionsEven though the provision of PC was empirically recognised as a care step in the management of dementia, there are barriers that hinder access of patients with dementia to appropriate facilities. With dementia prevalence rising and no cure on the horizon, it is crucial that health and social care regulatory bodies integrate a palliative approach into their care using the identified facilitators to achieve optimal and effective PC in this population.
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87
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Hou X, Lu Y, Yang H, Guo R, Wang Y, Wen L, Zhang Y, Sun H. Preferences for a good death: a cross-sectional survey in advanced cancer patients. BMJ Support Palliat Care 2019; 12:e570-e577. [PMID: 30944121 DOI: 10.1136/bmjspcare-2018-001750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to describe preferences for a good death among Chinese patients with advanced cancer and then to explore factors contributing to their preferences including patient demographics and disease variables. METHODS A convenience sample of 275 patients with advanced cancer was recruited from a tertiary cancer hospital in Beijing, China, between February and December 2017. A Chinese version of the Good Death Inventory (GDI) was used to measure patients' preferences for dying and death. Besides, data were collected using a multi-itemed questionnaire focusing on demographic and disease characteristics of patients. RESULTS Of the 275 questionnaires returned, 248 responses were analysed (effective response rate 90.2%). According to the total scores for each of the 20 domains, the five most important domains of a good death were: good relationship with family (19.80±2.39), independence (19.66±2.56), maintaining hope and pleasure (19.56±2.55), good relationship with medical staff (18.92±3.73), not being a burden to others (18.89±3.30). Patients' characteristics including age, educational status, religious belief, medical payment types, family economic status, past experiences of the death of others, the period since cancer diagnosis, past experiences of hospitalisation and subjective physical condition influenced their preferences for a good death (all p<0.05). CONCLUSIONS We had an in-depth knowledge and understanding of their preferences for good death among Chinese patients with advanced cancer. Meanwhile, we found some patients' factors contributed to different preferences for a good death. These findings have the potential to guide hospice care services aimed at achieving a good death for patients with advanced cancer.
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Affiliation(s)
- Xiaoting Hou
- Department of Thoracic Oncology Ⅰ, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yuhan Lu
- Nursing Administrative Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Hong Yang
- Nursing Administrative Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Renxiu Guo
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yun Wang
- Department of Integrative Medicine and Geriatric Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lihong Wen
- Interventional Therapy Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yaru Zhang
- Departement of Radiation Therapy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Hongyu Sun
- Humanities Teaching and Research Section, School of Nursing, Peking University, Beijing, China
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Park CH, Shin DW, Choi JY, Kang J, Mo HN, Baik YJ, Kim YH, Kang MJ, Gwak JI, Lee JJ. Determinants of Family Satisfaction with Inpatient Palliative Care in Korea. J Palliat Care 2018. [DOI: 10.1177/082585971302900205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We aimed to identify which structures and processes of care are key determinants of overall satisfaction with palliative care. Methods: A nationwide, multicentre, cross-sectional questionnaire survey was conducted with 501 bereaved family members of terminal cancer patients (effective response rate: 20.9 percent). Structures and processes were evaluated using the Care Evaluation Scale (CES). Results: In univariate analyses, all domains of the CES were significantly associated with overall satisfaction with care. In multivariate analyses, the domains of physical care by physician, physical care by nurse, environment, and coordination positively influenced overall satisfaction. After case-mix adjustment, physical care by nurse, age of patient, and lower education level of bereaved family member remained as significant determinants. Conclusion: Our finding that nursing is the most critical determinant of overall satisfaction within many structure and process domains has an important implication for clinical quality improvement and resource allocation.
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Affiliation(s)
- Chang-Hae Park
- DW Shin (corresponding author) Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Dong-Wook Shin
- DW Shin (corresponding author) Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Jin Young Choi
- Department of Family Medicine, Eulji University Hospital, Daejeon, Korea, and Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jina Kang
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Ha Na Mo
- Daegu Medical Center, Daegu, Republic of Korea
| | - Young Ji Baik
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Yeo Hwan Kim
- okpo Jung Ang Hospital, Mokpo, Republic of Korea
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Kupeli N, Candy B, Tamura-Rose G, Schofield G, Webber N, Hicks SE, Floyd T, Vivat B, Sampson EL, Stone P, Aspden T. Authors' Reply to Montoya et al. Comment On: "Tools Measuring Quality of Death, Dying, and Care, Completed After Death: Systematic Review of Psychometric Properties". PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 12:169. [PMID: 30506438 DOI: 10.1007/s40271-018-0351-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Guy Schofield
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | | | | | - Theodore Floyd
- Emergency Department, Medway Maritime Hospital NHS Trust, Kent, UK
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Trefor Aspden
- Division of Psychiatry, University College London, London, UK
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Comment on: Tools Measuring Quality of Death, Dying, and Care, Completed After Death: Systematic Review of Psychometric Properties. THE PATIENT 2018; 12:167. [PMID: 30506437 DOI: 10.1007/s40271-018-0350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mori M, Sasahara T, Morita T, Aoyama M, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Achievement of a good death among young adult patients with cancer: analyses of combined data from three nationwide surveys among bereaved family members. Support Care Cancer 2018; 27:1519-1527. [PMID: 30446856 DOI: 10.1007/s00520-018-4539-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Although little improvement has been made in the survival rate among young cancer patients over recent decades, whether they have achieved a good death has never been systematically explored. We aimed to clarify whether young cancer patients (aged 20-39 years) have achieved a good death, and compare their achievement with that of middle-aged patients (aged 40-64 years). METHODS We analyzed combined data of three nationwide, cross-sectional surveys of families of cancer patients who died at inpatient hospices in Japan (2007-2014). We measured 10 core items of the Good Death Inventory (GDI) short-version on a 7-point scale, and calculated rates of "agree/absolutely agree" and the mean scores. RESULTS We analyzed 245 and 5140 responses of families of young and middle-aged patients, respectively. Less than 60% of families of young patients reported "agree/absolutely agree" regarding 9 items, which included "feeling that one's life was completed" in 44 (18%; 95% confidence interval (CI) = 14-23%), "being independent in daily life" in 48 (20%; 95% CI = 15-25%), and "being free from physical distress" in 103 (42%; 95% CI = 36-48%) young patients. Young patients were significantly less likely to feel "one's life was completed" (mean = 3.3 (standard deviation = 2.0) vs. 3.8 (1.9), respectively; effect size (ES) = 0.29; adjusted p value = 0.000) and "not being a burden to others" (3.1 (1.5) vs. 3.5 (1.6), respectively; ES = 0.24; adjusted p value = 0.010) than the middle-aged. CONCLUSIONS Overall, young cancer patients did not achieve a good death. Future efforts are needed to improve the quality of palliative care for young patients, focusing on psychosocial/spiritual suffering.
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Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan.
| | - Tomoyo Sasahara
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Amakubo 1-3-1, Tsukuba City, Ibaraki, 305-8558, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
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Kanno Y, Sato K, Shimizu M, Funamizu Y, Andoh H, Kishino M, Senaga T, Takahashi T, Miyashita M. Validity and Reliability of the Dying Care Process and Outcome Scales Before and After Death From the Bereaved Family Members' Perspective. Am J Hosp Palliat Care 2018; 36:130-137. [PMID: 29945455 DOI: 10.1177/1049909118785178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: There are no instruments evaluating the processes and outcomes of dying care right before and after death. Therefore, we developed and examined the validity and reliability of 2 scales for evaluating dying care processes and outcomes before and after death. METHODS: A cross-sectional, anonymous questionnaire was administered to bereaved family members of patients with cancer who had died in 5 facilities. We evaluated the Dying Care Process Scale for Bereaved Family Members (DPS-B) and the Dying Care Outcome Scale for Bereaved Family Members (DOS-B) with 345 bereaved family members. RESULTS: A factor analysis revealed that DPS-B and DOS-B each consisted of 4 subscales. For the DPS-B, they were "symptom management," "respect for the patient's dignity before and after death," "explanation to the family," and "family care." For the DOS-B, they were "peaceful dying process for the patient," "being respected as a person before and after death," "good relationship between the patient and family," and "peaceful dying process for the family." Both DPS-B and DOS-B had sufficient convergent and discriminative validity, sufficient internal consistency (DPS-B: α = 0.91 and subscales' αs = 0.78-0.91; DOS-B: α = 0.91 and subscales' αs = 0.78-0.94), and sufficient test-retest reliability (DPS-B: intraclass correlation coefficient [ICC] of total score = 0.79 and subscales = 0.55-0.79; DOS-B: ICC of total score = 0.88 and subscales = 0.70-0.88). SIGNIFICANCE OF RESULTS: Both DPS-B and DOS-B are valid and reliable scales for evaluating the dying care processes and outcomes before and after death from the bereaved family members' perspectives.
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Affiliation(s)
- Yusuke Kanno
- 1 Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan.,2 Division of Psycho-Oncology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Chiba, Japan
| | - Kazuki Sato
- 1 Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan.,3 Department of Nursing, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Megumi Shimizu
- 1 Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan.,4 Clinical Research, Innovation, and Education Center, Tohoku University Hospital, Miyagi, Japan
| | - Yuko Funamizu
- 5 Department of Palliative Care Team, Nakadori General Hospital, Akita, Japan
| | - Hideaki Andoh
- 6 Department of Clinical Nursing, Akita University Graduate School of Health Science, Akita, Japan
| | - Megumi Kishino
- 7 Department of Palliative Care Unit, Shimura Hospital, Hiroshima, Japan.,8 Department of Nursing/Palliative Care Team, Kobe University Hospital, Hyogo, Japan
| | - Tomomi Senaga
- 9 Department of Palliative Care Unit, Adventist Medical Center, Okinawa, Japan
| | - Tetsu Takahashi
- 10 Department of Surgery, Koga General Hospital, Miyazaki, Japan.,11 Yusho-Kai Home Medical Care Clinic, Kita-Senju, Japan
| | - Mitsunori Miyashita
- 1 Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
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93
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Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. The Japan hospice and palliative evaluation study 4: a cross-sectional questionnaire survey. BMC Palliat Care 2018; 17:66. [PMID: 29678173 PMCID: PMC5909241 DOI: 10.1186/s12904-018-0319-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022] Open
Abstract
Background Constant evaluation is important for maintaining and improving the quality of end-of-life care. We therefore conduct the fourth Japan Hospice and Palliative Evaluation Study (J-HOPE4) as a continuous evaluation study. In this present paper, we describe the design of J-HOPE4. The main purposes of J-HOPE4 are as follows:1) to evaluate the processes, structures, and outcomes of palliative care acute hospitals, palliative care units, and home hospice services; 2) to examine bereaved family members’ self-reported psychosocial conditions, such as grief and depression as bereavement outcomes;3) to provide data to ensure and improve the quality of care provided by participating institutions via feedback based on the results from each institution; and 4) provide clinical and academic information concerning the implications of various issues in palliative care by conducting additional studies. Methods We will conduct a cross-sectional, anonymous, self-reported questionnaire survey. In total, 190 institutions will participate in this study, meaning that 12,000 bereaved family members will be sent a questionnaire. Discussion This is one of the largest cross-sectional surveys involving hospice and palliative care, both in Japan and worldwide. Because this study will have a large sample size, the findings are expected to be generalizable to other settings.
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Affiliation(s)
- Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamtsu, Shizuoka, 433-8558, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuoku, Kobe, Hyogo, 650-0017, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Saikyo-ku, Kyoto, 606-8507, Japan
| | - Yasuo Shima
- Tsukuba Medical Center Foundation, Home Care Service, Tsukuba Medical Center Hospital, Department of Palliative Medicine, 1-3-1, Amakubo, Tsukuba, Ibaraki, 305-8558, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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94
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Masukawa K, Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. The Japan hospice and palliative evaluation study 4: a cross-sectional questionnaire survey. BMC Palliat Care 2018. [PMID: 29678173 DOI: 10.1186/s12904‐018‐0319‐z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Constant evaluation is important for maintaining and improving the quality of end-of-life care. We therefore conduct the fourth Japan Hospice and Palliative Evaluation Study (J-HOPE4) as a continuous evaluation study. In this present paper, we describe the design of J-HOPE4. The main purposes of J-HOPE4 are as follows:1) to evaluate the processes, structures, and outcomes of palliative care acute hospitals, palliative care units, and home hospice services; 2) to examine bereaved family members' self-reported psychosocial conditions, such as grief and depression as bereavement outcomes;3) to provide data to ensure and improve the quality of care provided by participating institutions via feedback based on the results from each institution; and 4) provide clinical and academic information concerning the implications of various issues in palliative care by conducting additional studies. METHODS We will conduct a cross-sectional, anonymous, self-reported questionnaire survey. In total, 190 institutions will participate in this study, meaning that 12,000 bereaved family members will be sent a questionnaire. DISCUSSION This is one of the largest cross-sectional surveys involving hospice and palliative care, both in Japan and worldwide. Because this study will have a large sample size, the findings are expected to be generalizable to other settings.
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Affiliation(s)
- Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamtsu, Shizuoka, 433-8558, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuoku, Kobe, Hyogo, 650-0017, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Saikyo-ku, Kyoto, 606-8507, Japan
| | - Yasuo Shima
- Tsukuba Medical Center Foundation, Home Care Service, Tsukuba Medical Center Hospital, Department of Palliative Medicine, 1-3-1, Amakubo, Tsukuba, Ibaraki, 305-8558, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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95
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Gutiérrez Sánchez D, Pérez Cruzado D, Cuesta-Vargas AI. The quality of dying and death measurement instruments: A systematic psychometric review. J Adv Nurs 2018; 74:1803-1818. [PMID: 29672911 DOI: 10.1111/jan.13687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
AIMS To identify instruments that could assess the quality of dying and death and their psychometric properties. To assess the methodological quality of studies on measurement properties. BACKGROUND A high quality of death is regarded as a goal at the end of life and, therefore, an assessment of the end of life experience is essential. Many instruments have been developed to evaluate the quality of dying and death. The selection of the most appropriate measure to be used in clinical and research settings is crucial. DESIGN Psychometric systematic review. DATA SOURCES We systematically searched ProQuest Medline, SciELO and ProQuest PsycINFO from 1970 - May 2016. REVIEW METHODS Identification and evaluation of instruments that assessed quality of dying and death. Papers were evaluated by two independent reviewers according to the COSMIN checklist with a 4-point scale. RESULTS A total of 19 studies were included in this review. Seven instruments were found that were specifically designed for assessing quality of dying and death. A retrospective carer proxy report to evaluate this construct was used in most of the papers. The methodological quality of the studies was fair for most of the psychometric characteristics analyzed. CONCLUSION Many instruments have been developed to assess the quality of dying and death. The Quality of Dying and Death Questionnaire is the best available measure of the quality of dying and death. It is the only questionnaire identified in this review where all psychometric properties according to the COSMIN checklist have been evaluated.
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Affiliation(s)
- Daniel Gutiérrez Sánchez
- Fundación Cudeca. Av. del Cosmos, s/n, 29631 Arroyo de la Miel, Málaga, Spain
- Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 Malaga, Spain
| | - David Pérez Cruzado
- Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 Malaga, Spain
| | - Antonio I Cuesta-Vargas
- Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 Malaga, Spain
- School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Queensland, Australia
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96
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Ross L, Neergaard MA, Petersen MA, Groenvold M. Measuring the quality of end-of-life care: Development, testing, and cultural validation of the Danish version of Views of Informal Carers' Evaluation of Services-Short Form. Palliat Med 2018; 32:804-814. [PMID: 29130380 DOI: 10.1177/0269216317740274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The perspectives of patients and relatives are important in the improvement of the quality of health care. However, the quality of end-of-life care has not been systematically evaluated in Scandinavia. AIM To develop or adapt and subsequently validate a questionnaire assessing the quality of end-of-life care in Denmark. The questionnaire was intended for bereaved relatives in order to assess the quality of care in the last 3 months of the patient's life and the circumstances surrounding death. DESIGN AND DATA SOURCES Based on the literature and interviews with 15 bereaved relatives and 17 healthcare professionals, relevant topics to include in a questionnaire were identified. The topics were prioritized by 100 bereaved relatives and subsequently compared to existing questionnaires. The chosen questionnaire was tested by cognitive interviews with 36 bereaved relatives. RESULTS Most of the important topics were covered by the Views of Informal Carers' Evaluation of Services-Short Form, but not all Danish settings (e.g. home care by a palliative team) were covered. These settings were added to the Views of Informal Carers' Evaluation of Services-Short Form, and a few adaptations were made before a Danish version of the Views of Informal Carers' Evaluation of Services-Short Form was tested by cognitive interviews. This cultural validation showed that the slightly adapted Danish version was perceived as relevant, understandable, and acceptable. Furthermore, the cognitive interviews gave insight in the comprehension and interpretation of Views of Informal Carers' Evaluation of Services-Short Form items. CONCLUSION With a few adaptations, the British Views of Informal Carers' Evaluation of Services-Short Form was relevant in a Danish setting.
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Affiliation(s)
- Lone Ross
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Mette Asbjoern Neergaard
- 2 The Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Morten Aagaard Petersen
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Mogens Groenvold
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark.,3 Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
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97
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Ishida M, Onishi H, Morita T, Uchitomi Y, Shimizu M, Tsuneto S, Shima Y, Miyashita M. Communication Disparity Between the Bereaved and Others: What Hurts Them and What Is Unhelpful? A Nationwide Study of the Cancer Bereaved. J Pain Symptom Manage 2018; 55:1061-1067.e1. [PMID: 29329691 DOI: 10.1016/j.jpainsymman.2017.12.493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/29/2017] [Accepted: 12/29/2017] [Indexed: 12/28/2022]
Abstract
CONTEXT The importance of communication between the cancer bereaved and others has been emphasized, but little is known about the more problematic aspects of this communication such as "unhelpful communication." OBJECTIVES The aim of this study was to establish which types of communication are perceived by the bereaved to be unhelpful. METHODS We conducted a cross-sectional, anonymous, nationwide survey at 103 certified hospice facilities/palliative care units in Japan. RESULTS A total of 630 (63%) bereaved responded. Over 60% of the bereaved experiencing such communication considered it to be unhelpful, with the most unhelpful communication being "They emphasized the positive aspects of death." Thirteen items related to communication were separated into two factors ("advice for recovery" and "comments on cancer") by factor analysis. "Comments on cancer" were more unhelpful to them and were more often provided by those around them. With regard to "advice for recovery," losing a spouse was a stronger predictor with a higher odds ratio for communication distress than losing a parent (odds ratio, 5.34; 95% CI, 1.63-17.57). CONCLUSION A number of the bereaved have experienced unhelpful communication regarding advice on dealing with bereavement and cancer. To prevent putting an unnecessary burden on the bereaved with such unhelpful communication, it is essential to understand problematic aspects. Even when people have no intention of hurting the bereaved, some communication may do so. Communication with the bereaved is also a core clinical skill required by health professionals, and further efforts are required to support the grieving process.
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Affiliation(s)
- Mayumi Ishida
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
| | - Hideki Onishi
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatagahara Hospital, Hamamatsu, Shizuoka, Japan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Megumi Shimizu
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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98
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Kim SM, Kown SH. [Influential Factors of Complicated Grief of Bereaved Spouses from Cancer Patient]. J Korean Acad Nurs 2018. [PMID: 29535285 DOI: 10.4040/jkan.2018.48.1.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to investigate variables and construct paths that affect complicated grief. METHODS Participants in this cross-sectional, descriptive study were 164 bereaved spouses of cancer patients at least 12 months before the death. Data were collected from October 2016 to February 2017 using self-report structured questionnaires and were analyzed using IBM SPSS 21.0 and AMOS 20.0. RESULTS The variables affecting complicated grief of bereaved spouses of cancer patients were the quality of end-of-life care (γ=.15, p<.001), preparedness for death (β=-.06, p=.005), and coping with bereavement (β=-.24, p<.001), whereas the quality of death and dying did not show any effects. Preparedness for death had multiple mediating effects in the relationship between the quality of end-of-life care and complicated grief (z=-2.20, p=.028), and in the relationship between the quality of end-of-life care and coping with bereavement (z=2.11, p=.035). Coping with bereavement had a mediating effect on the relationship between preparedness for death and complicated grief (z=-2.39, p=.017). CONCLUSION This study revealed that preparedness for death and coping with bereavement play a prominent role in complicated grief. Therefore, it is important to help in preparing for death and enhancing coping with bereavement of spouses providing end-of-life care to cancer patients. In addition, investigating cultural differences in the relationship between the quality of end-of-life care and complicated grief is recommended.
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Affiliation(s)
- So Myeong Kim
- College of Nursing, Taegu Science University, Daegu, Korea
| | - So Hi Kown
- College of Nursing · The Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea.
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99
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Mori M, Yoshida S, Shiozaki M, Morita T, Baba M, Aoyama M, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. “What I Did for My Loved One Is More Important than Whether We Talked About Death”: A Nationwide Survey of Bereaved Family Members. J Palliat Med 2018; 21:335-341. [DOI: 10.1089/jpm.2017.0267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Saran Yoshida
- Graduate School of Education, Tohoku University, Sendai, Japan
| | - Mariko Shiozaki
- Department of Applied Sociology, Kindai University, Osaka, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Mika Baba
- Department of Palliative Medicine, Suita Tokushukai Hospital, Osaka, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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100
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Moss KO, Douglas SL. Family Caregiver Satisfaction With End-of-Life Care Following Advanced Cancer. ONCOLOGY NURSING NEWS 2018; 12:32. [PMID: 30464780 PMCID: PMC6242339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Karen O Moss
- Postdoctoral fellow, Frances Payne Bolton School of Nursing Case Western Reserve University, in Cleveland, Ohio
| | - Sara L Douglas
- Arline H. & Curtis F. Garvin Professor and assistant dean for research, Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, Ohio
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