101
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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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102
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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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103
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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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104
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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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105
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Horinuki F, Noguchi-Watanabe M, Takai Y, Yamahana R, Ohno N, Okada S, Mori SI, Yamamoto-Mitani N. The Experience of Persons With Hematological Malignancy When Communicating With Health Care Professionals. QUALITATIVE HEALTH RESEARCH 2018; 28:479-490. [PMID: 29103363 DOI: 10.1177/1049732317739839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aimed to elucidate the experiences of Japanese persons with hematological malignancy (PHMs) in communicating with health care professionals (HCPs), from diagnosis to the end of life, as recalled by their families. We interviewed 14 bereaved families and analyzed the data using the basic techniques of grounded theory. We found that PHMs lived to the fullest possible when they experienced ownership of their illness process despite their disease. The ownership was made possible by active communication from HCPs: first, acknowledging the PHM's way of life, including reaching out from the HCPs and appreciating sincerely PHMs' hopes and will; and second, paving the way ahead, including giving prospects and offering choices. The study underlines that rather than just providing information about the disease, HCPs need to actively ask about and show respect for the PHM's way of life. Only after achieving this can HCPs communicate possible future pathways with PHMs.
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Affiliation(s)
| | | | - Yukari Takai
- 2 Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | | | | | - Sadamu Okada
- 3 St. Luke's International Hospital, Tokyo, Japan
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106
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Mori M, Morita T, Igarashi N, Shima Y, Miyashita M. Communication about the impending death of patients with cancer to the family: a nationwide survey. BMJ Support Palliat Care 2018; 8:221-228. [DOI: 10.1136/bmjspcare-2017-001460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesExplanation about the impending death of imminently dying patients with cancer is important for their families. However, little is known about how clinicians explain impending death and how families perceive the explanation. We aimed to clarify bereaved families’ perception of the need for improvements in the explanation about impending death and to explore the factors contributing to the need.MethodsIn a nationwide survey of 818 bereaved families of patients with cancer admitted to inpatient hospices in Japan, we evaluated family-perceived need for improvements in the explanation about impending death and families’ experiences of the explanation.ResultsAmong all the participants (n=516, 63%), 35 (6.8%), 123 (24%) and 297 (58%) families felt that much/considerable, some and no improvements were needed, respectively. Independent determinants of the need were a younger patient age (OR=0.97; 95% CI 0.95 to 0.99; P=0.009); not receiving an ‘explicit explanation about physical signs of impending death’ (OR=0.67; 95% CI 0.51 to 0.88; P=0.004); not receiving an ‘explanation of how long the patient and family could talk’ (OR=0.67; 95% CI 0.51 to 0.88; P<0.001); receiving an ‘excessive warning of impending death’ (OR=1.45; 95% CI 1.03 to 2.03; P=0.033) and having a feeling of ‘uncertainty caused by vague explanations about future changes’ (OR=1.77; 95% CI 1.38 to 2.27; P<0.001).ConclusionsNearly a third of the bereaved families perceived some need to improve the explanation about impending death. To better help patients/families prepare for their end-of-life, clinicians should recognise and explain various impending death signs; find a balance between detailed explanation and excessive warning and address how long they could talk in the remaining time.
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107
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Aoyama M, Sakaguchi Y, Morita T, Ogawa A, Fujisawa D, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Factors associated with possible complicated grief and major depressive disorders. Psychooncology 2018; 27:915-921. [DOI: 10.1002/pon.4610] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Maho Aoyama
- Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | | | - Tatsuya Morita
- Seirei Mikatahara General Hospital; Hamamatsu Shizuoka Japan
| | - Asao Ogawa
- National Cancer Center Hospital East; Kashiwa Chiba Japan
| | | | | | - Satoru Tsuneto
- Graduate School of Medicine Kyoto University; Kyoto Japan
| | - Yasuo Shima
- Tsukuba Medical Center Hospital; Tsukuba Ibaraki Japan
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108
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Mori M, Kuwama Y, Ashikaga T, Parsons HA, Miyashita M. Acculturation and Perceptions of a Good Death Among Japanese Americans and Japanese Living in the U.S. J Pain Symptom Manage 2018; 55:31-38. [PMID: 28842219 DOI: 10.1016/j.jpainsymman.2017.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 11/30/2022]
Abstract
CONTEXT Acculturation is the phenomenon of the attitudinal changes of individuals who come into continuous contact with another culture. Despite the long history of Japanese immigration to America, little is known about the impact of acculturation on perceptions of a good death. OBJECTIVES To examine differences in perceptions of a good cancer death among Japanese Americans (JA/A), Japanese living in America (J/A), and the Japanese living in Japan (J/J). METHODS We administered surveys among JA/A and J/A and used historical J/J data for reference. Primary endpoint was the proportion of respondents who expressed the necessity of core and optional items of the Good Death Inventory. Group differences ≥20% were deemed clinically important. RESULTS In total, 441 survey responses in America and 2548 in Japan were obtained. More than 80% of respondents consistently considered nine of 10 core items necessary without significant group differences. No core item reached a ≥20% group difference. Three of the eight optional items reached ≥20% group difference: fighting against disease until one's last moment (49%, P < 0.0001; 52%, P < 0.0001; and 73% in JA/A, J/A, and J/J, respectively), knowing what to expect about one's condition in the future (83%, P < 0.0001; 80%, P < 0.0001; and 58%, respectively), and having faith (64%, P = 0.0548; 43%, P = 0.0127; and 38%, respectively). CONCLUSION Although most core items of a good death were preserved throughout the levels of acculturation, perceptions of some optional items shifted away from Japanese attitudes as individuals became more acculturated. Understanding of different levels of acculturation may help clinicians provide culturally sensitive end-of-life care.
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Affiliation(s)
- Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Shizuoka, Japan.
| | - Yuichiro Kuwama
- Mount Sinai Beth Israel, Japanese Medical Practice, New York, New York
| | - Takamaru Ashikaga
- Department of Medical Biostatistics, University of Vermont College of Medicine, Burlington, Vermont
| | - Henrique A Parsons
- Department of Medicine/Division of Palliative Care, University of Ottawa, Ontario, Canada
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
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109
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Mori M, Yoshida S, Shiozaki M, Baba M, Morita T, Aoyama M, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Talking About Death With Terminally-Ill Cancer Patients: What Contributes to the Regret of Bereaved Family Members? J Pain Symptom Manage 2017; 54:853-860.e1. [PMID: 28797852 DOI: 10.1016/j.jpainsymman.2017.02.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/08/2017] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Abstract
CONTEXT Talking about death is an important issue for terminally-ill cancer patients and their families. Little is known about how often and which bereaved families regret not having talked about death with their deceased loved one. OBJECTIVES To explore the prevalence of a regret of not having talked about death with a deceased loved one among bereaved family members of adult cancer patients, and to systematically explore factors contributing to their regret. METHODS We conducted a nationwide survey of 999 bereaved families of cancer patients admitted to 133 inpatient hospices in Japan and surveyed families' regret on talking about death. Exploratory analyses identified the underlying structures of process, option, and outcome subscales of factors contributing to regret. RESULTS Among 678 bereaved families (response rate 68%), 224 (33%) regretted not having talked about death sufficiently, whereas 40 (5.9%) conversely regretted having talked about death. Three process factors ("prognostic disclosure to patient" [β = 0.082, P = 0.039], "upsetting of patient and family" [β = 0.127, P = 0.001], and "family's sense of uncertainty about when to act based on terminal awareness" [β = 0.141, P = 0.000]) and an outcome factor ("having achieved a good death" [β = -0.152, P = 0.000]) contributed to the regret of talking insufficiently. CONCLUSION A third of bereaved families of adult cancer patients regretted not having talked about death sufficiently. Clinicians may minimize this regret by facilitating a shared understanding of the disease and prognosis, advising families explicitly when to talk based on terminal awareness, providing continuous emotional support, and validating their decision on talking about death.
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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
| | - Mika Baba
- Department of Palliative Medicine, Suita Tokushukai Hospital, Suita, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Maho Aoyama
- Department of Community Health, 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 Community Health, Tohoku University Graduate School of Medicine, Sendai, Japan
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110
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Yamashita R, Arao H, Takao A, Masutani E, Morita T, Shima Y, Kizawa Y, Tsuneto S, Aoyama M, Miyashita M. Unfinished Business in Families of Terminally Ill With Cancer Patients. J Pain Symptom Manage 2017; 54:861-869. [PMID: 28807700 DOI: 10.1016/j.jpainsymman.2017.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/07/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Unfinished business often causes psychological issues after bereavement. Providing care for families of terminally ill patients with cancer to prevent unfinished business is important. OBJECTIVES To clarify the prevalence and types of unfinished business in families of end-of-life patients with cancer admitted to palliative care units (PCUs), explore depression and grief associated with unfinished business, and explore the factors affecting unfinished business. METHODS We conducted a cross-sectional, anonymous, self-report questionnaire survey with 967 bereaved families of patients with cancer admitted to PCUs. The questionnaire assessed the presence or the absence of unfinished business, content of unfinished business, depression, grief, process of preparedness, condition of the family and patient, and the degree of involvement of health care professionals. RESULTS Questionnaires were sent to 967 families, and 73.0% responded. In total, 26.0% of families had some unfinished business, with improvement of the patient-family relationship being a common type of unfinished business. Families with unfinished business had significantly higher depression and grief scores after bereavement compared with those without. Factors that influenced the presence or the absence of unfinished business were preparedness for the patient's death (P = 0.001), discussion between the patient and family about the disease trajectory and way to spend daily life (P < 0.001), good patient-family relationship (P = 0.011), and family and health care professionals considering together the appropriate timing to accomplish the family's wishes (P = 0.021). CONCLUSION Many families have unfinished business. Health care professionals should coordinate the appropriate timing for what the family wishes to do, with consideration of family dynamics, including the family's preparedness, communication pattern, and relationships.
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Affiliation(s)
- Ryoko Yamashita
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Harue Arao
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Ayumi Takao
- Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Eiko Masutani
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Maho Aoyama
- Department of Community Health, Course of Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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111
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Oosono Y, Yokoyama K, Itoh H, Enomoto M, Ishiwata M. Discrepancies Between the Supports Needed for Discharge of Patients With Terminal Cancer to Family Caregivers and What Supports Were Actually Provided in Japan: Assessment of Palliative Care Unit Nurses. Am J Hosp Palliat Care 2017; 35:704-711. [PMID: 29172637 DOI: 10.1177/1049909117741586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Even if patients with terminal cancer hope to spend the rest of their lives at home, they are often unable to leave the hospital early due to their family caregivers' anxiety. This study aimed to investigate in Japan the discrepancies between the supports needed by and actually provided by palliative care unit nurses (PCUNs) to the family caregivers for discharge of patients with terminal cancer. METHODS In this cross-sectional study, self-administered questionnaires including 6-point Likert-type scales assessing the reasons for difficulties in transition to home-based care were distributed to 1227 PCUNs. Using paired t tests, the differences between the scores on perceived importance and actual supports to family caregivers were examined. The supports actually provided were classified by factor analysis. The relationships between the PCUNs' characteristics and mean scores on the supports in each category were examined using multiple regression analysis. RESULTS A total of 1023 (83.4%) completed questionnaires were returned. Scores on the actually provided supports for discharge to family caregivers were consistently and significantly lower than the corresponding scores on perceived importance for all 57 items ( P < .001). Factor analysis revealed that the supports actually provided to the family caregivers had a 4-factor structure. Multiple regression analyses revealed that gaining experience in palliative care, receiving necessary training, cooperating with palliative care staff, and cooperating with local service providers were significantly associated with higher levels of actual supply of supports to family caregivers. CONCLUSION Our findings suggest that PCUNs need to be encouraged to provide further support to family caregivers for the discharge of patients with terminal cancer.
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Affiliation(s)
- Yasufumi Oosono
- 1 Division of Nursing, National Defense Medical College, Tokorozawa, Saitama, Japan.,2 Department of Epidemiology and Environmental Health, Jutendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuhito Yokoyama
- 2 Department of Epidemiology and Environmental Health, Jutendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Itoh
- 2 Department of Epidemiology and Environmental Health, Jutendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | | | - Miki Ishiwata
- 4 Yokohama Municipal Citizen's Hospital, Hodogaya-ku, Yokohama, Japan
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112
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Abstract
Introduction A main goals of palliative care is to improve the health-related quality of life (QOL) of patients with advanced illnesses. The objective of this narrative review is to provide an updated synopsis on the use of QOL questionnaires in the palliative care setting. Areas covers Focusing on the palliative cares setting, we will define QOL, discuss how QOL instruments can be used clinically and in research, review approaches to validate these questionnaires, and how they can be used in utility analyses. Expert opinion/commentary Several QOL questionnaires, such as EORTC-QLQ-C30, McGill QOL questionnaire and EQ-5D have been validated in the palliative care setting. However, significant gaps impede their application, including lack of determination of their responsiveness to change and minimal clinically important differences, the need to conduct more psychometric validation on QOL questionnaires among patients at various stages of disease trajectory, and the paucity of studies examining utility and cost-effectiveness. Further research is needed to address these knowledge gaps so QOL questionnaires can be better used to inform clinical practice and research.
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Affiliation(s)
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD D Anderson Cancer Center, Houston, TX, USA, 77030
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113
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Hunt KJ, Richardson A, Darlington ASE, Addington-Hall JM. Developing the methods and questionnaire (VOICES-SF) for a national retrospective mortality follow-back survey of palliative and end-of-life care in England. BMJ Support Palliat Care 2017; 9:e5. [PMID: 29101120 DOI: 10.1136/bmjspcare-2016-001288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 07/31/2017] [Accepted: 09/15/2017] [Indexed: 11/04/2022]
Abstract
The National Survey of Bereaved People was conducted by the Office for National Statistics on behalf of NHS England for the first time in 2011, and repeated annually thereafter. It is thought to be the first time that nationally representative data have been collected annually on the experiences of all people who have died, regardless of cause and setting, and made publicly available informing palliative and end-of-life policy, service provision and development, and practice. This paper describes the development of the questionnaire used in the survey, VOICES-SF, a short-form of the VOICES (Views Of Informal Carers-Evaluation of Services) questionnaire, adapted specifically to address the aims of the national survey. The pilot study to refine methods for the national survey is also described. The paper also reports on the development of the retrospective, after-death or mortality follow-back method in palliative and end-of-life care, and reviews its strengths and weaknesses.
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Affiliation(s)
- Katherine J Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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114
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Kwan CWM, Ng MSN, Chan CH. The use of life review to enhance spiritual well-being in patients with terminal illnesses: An integrative review. J Clin Nurs 2017; 26:4201-4211. [DOI: 10.1111/jocn.13977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Cecilia W M Kwan
- Bradbury Hospice; New Territories East Cluster, Hospital Authority; Hong Kong SAR China
| | - Marques S N Ng
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Hong Kong SAR China
| | - Carmen W H Chan
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Hong Kong SAR China
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115
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Choi J, Kong K, Chang Y, Jho H, Ahn E, Choi S, Park S, Lee M. Effect of the duration of hospice and palliative care on the quality of dying and death in patients with terminal cancer: A nationwide multicentre study. Eur J Cancer Care (Engl) 2017; 27:e12771. [DOI: 10.1111/ecc.12771] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 01/27/2023]
Affiliation(s)
- J.Y. Choi
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - K.A. Kong
- Department of Preventive Medicine; College of Medicine; Ewha Womans University; Seoul South Korea
| | - Y.J. Chang
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - H.J. Jho
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - E.M. Ahn
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - S.K. Choi
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - S. Park
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - M.K. Lee
- College of Nursing; Research Institute of Nursing Science; Kyungpook National University; Daegu South Korea
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Otani H, Yoshida S, Morita T, Aoyama M, Kizawa Y, Shima Y, Tsuneto S, Miyashita M. Meaningful Communication Before Death, but Not Present at the Time of Death Itself, Is Associated With Better Outcomes on Measures of Depression and Complicated Grief Among Bereaved Family Members of Cancer Patients. J Pain Symptom Manage 2017; 54:273-279. [PMID: 28711756 DOI: 10.1016/j.jpainsymman.2017.07.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/27/2017] [Accepted: 07/06/2017] [Indexed: 01/30/2023]
Abstract
CONTEXT Few studies have explored the clinical significance of the family's presence or absence at the moment of a patient's death and meaningful communication (saying "goodbye") in terms of post-bereavement outcomes. OBJECTIVES To explore the potential association between the family's depression/complicated grief and their presence at the moment of a patient's death and the patient's communication with the family. METHODS A nationwide questionnaire survey was conducted on 965 family members of cancer patients who had died at palliative care units. RESULTS More than 90% of family members wished to have been present at the moment of death (agree: 40%, n = 217; strongly agree: 51%, n = 280); 79% (n = 393) thereof were present. Families' presence at death was not significantly associated with the occurrence of depression and complicated grief, but the dying patient's ability to say "goodbye" to the family beforehand was (depression: adjusted odds rate, 0.42; 95% CI, 0.26-0.69 adjusted P = 0.001; complicated grief: adjusted odds rate, 0.53; 95% CI, 0.29-0.94 adjusted P = 0.009). CONCLUSION Many families wished to be present at the moment of the patient's death; however, meaningful communication (saying "goodbye") between the patient and family members, and not their presence or absence itself, was associated with better outcomes on measures of depression or complicated grief. Health care professionals could consider promoting both mutual communication (relating to preparation for death) between family members and patients before imminent death, as well as the family's presence at the moment of death.
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Affiliation(s)
- Hiroyuki Otani
- Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka, Japan.
| | - Saran Yoshida
- Department of Clinical Psychology, Tohoku University Graduate School of Education, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Maho Aoyama
- Department of Community Health, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Satoru Tsuneto
- Palliative Care Center, Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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117
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Designing and Validation Islamic Evidence-Based Spiritual Care Guidelines of Sound Heart Model in the Dying Patients. ACTA ACUST UNITED AC 2017. [DOI: 10.5812/ccn.58079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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118
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Hamano J, Morita T, Fukui S, Kizawa Y, Tunetou S, Shima Y, Kobayakawa M, Aoyama M, Miyashita M. Trust in Physicians, Continuity and Coordination of Care, and Quality of Death in Patients with Advanced Cancer. J Palliat Med 2017; 20:1252-1259. [PMID: 28731821 DOI: 10.1089/jpm.2017.0049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Provider-centered factors contribute to unexplained variation in the quality of death (QOD). The relationship between healthcare providers (HCPs) and patients, bidirectional communication, and consistency of longitudinal care planning are important provider-centered factors. OBJECTIVE To explore whether the level of trust in HCPs, the quality of continuity of care, and the level of coordination of care among home HCPs are associated with the QOD for cancer patients dying at home. DESIGN This study was a part of a nationwide multicenter questionnaire survey of bereaved family members of cancer patients evaluating the quality of end-of-life care in Japan. SETTING/SUBJECTS We investigated 702 family members of cancer patients who died at home. MEASUREMENTS The QOD was evaluated from nine core domains of the short version of the Good Death Inventory (GDI). We measured five factors on a Likert scale, including patient and family trust in HCPs, continuity of care by home hospice and hospital physicians, and coordination of care among home hospice staff. RESULTS A total of 538 responses (77%) were obtained and 486 responses were analyzed. Trust in HCPs was correlated with the GDI score (r = 0.300-0.387, p < 0.001). The quality of care coordination was associated with the GDI score (r = 0.242, p < 0.001). CONCLUSIONS Trust of the patient and family in home hospice staff, as well as coordination of care among hospice staff, are associated with the QOD for cancer patients dying at home.
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Affiliation(s)
- Jun Hamano
- 1 Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba , Tsukuba, Japan
| | - Tatsuya Morita
- 2 Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital , Hamamtsu, Japan
| | - Sakiko Fukui
- 3 Department of Community Health Nursing, Graduate School of Nursing, The Japanese Red Cross University , Tokyo, Japan
| | - Yoshiyuki Kizawa
- 4 Department of Palliative Medicine, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Satoru Tunetou
- 5 Department of Human Health Sciences, Graduate School of Medicine, Kyoto University , Kyoto, Japan
| | - Yasuo Shima
- 6 Home Care Service, Department of Palliative Medicine, Tsukuba Medical Center Foundation, Tsukuba Medical Center Hospital , Tsukuba, Japan
| | - Makoto Kobayakawa
- 7 Palliative Care Team, Hiroshima University Hospital , Hiroshima, Japan
| | - Maho Aoyama
- 8 Department of Community Health, Health Sciences, Tohoku University Graduate School of Medicine , Sendai, Japan
| | - Mitsunori Miyashita
- 9 Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine , Sendai, Japan
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119
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Yamaguchi T, Maeda I, Hatano Y, Mori M, Shima Y, Tsuneto S, Kizawa Y, Morita T, Yamaguchi T, Aoyama M, Miyashita M. Effects of End-of-Life Discussions on the Mental Health of Bereaved Family Members and Quality of Patient Death and Care. J Pain Symptom Manage 2017; 54:17-26.e1. [PMID: 28450216 DOI: 10.1016/j.jpainsymman.2017.03.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 11/24/2022]
Abstract
CONTEXT End-of-life discussions are crucial for providing appropriate care to patients with advanced cancer at the end of their lives. OBJECTIVES The objective of this study was to explore associations between end-of-life discussions and bereaved families' depression and complicated grief and the quality of patient death and end-of-life care. METHODS A nationwide questionnaire survey of bereaved family members was conducted between May and July 2014. A total of 13,711 bereaved family members of cancer patients who were cared for by specialist palliative care services at 75 institutions throughout Japan and died before January 2014 participated. We evaluated the prevalence of depression (defined as the Patient Health Questionnaire-9 ≥ 10) and complicated grief (defined as the Brief Grief Questionnaire ≥ 8) in bereaved family members. Moreover, we evaluated the quality of death and end-of-life care with the Good Death Inventory and the Care Evaluation Scale, respectively. RESULTS A total of 9123 questionnaires were returned (response rate 67%), and 80.6% of the respondents reported that they had end-of-life discussions. After propensity score-weighted adjustment, the results showed that bereaved family members who had end-of-life discussions had a lower frequently of depression (17.3% vs. 21.6%; P < 0.001) and complicated grief (13.7% vs. 15.9%; P = 0.03). End-of-life discussions were associated with better quality of death (the Good Death Inventory score, 47.2 ± 8.5 vs. 46.1 ± 9.4; P < 0.001) and end-of-life care (the Care Evaluation Scale score, 84.1 ± 11.4 vs. 78.9 ± 14.3; P < 0.001). CONCLUSION End-of-life discussions may contribute to reducing depression and complicated grief in bereaved family members and enable patients to experience quality end-of-life care and a good death.
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Affiliation(s)
- Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Palliative Care, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan.
| | - Isseki Maeda
- Gratia Hospice, Gratia Research and Clinical Education (GRACE) Center, Gratia Hospital, Minoh, Japan
| | - Yutaka Hatano
- Department of Psychosomatic Medicine, Kinki University Hospital, Osaka-Sayama, Japan
| | - Masanori Mori
- Department of Laboratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Maho Aoyama
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Cabañero-Martínez MJ, Congost-Maestre N, Fernández-de-Maya J, Jiménez-García S, Richart-Martínez M. Linguistic validation of the Spanish version of the Good Death Inventory / Validación lingüística de la versión española del Good Death Inventory. STUDIES IN PSYCHOLOGY 2017. [DOI: 10.1080/02109395.2017.1328381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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121
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Hirooka K, Fukahori H, Taku K, Togari T, Ogawa A. Quality of death, rumination, and posttraumatic growth among bereaved family members of cancer patients in home palliative care. Psychooncology 2017; 26:2168-2174. [DOI: 10.1002/pon.4446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Kayo Hirooka
- Department of System Management in Nursing, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroki Fukahori
- Department of System Management in Nursing, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Kanako Taku
- Department of Psychology; Oakland University; Rochester MI USA
| | - Taisuke Togari
- Faculty of Liberal Arts; The Open University of Japan; Chiba Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Research Center for Innovative Oncology; National Cancer Center Hospital East; Chiba Japan
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122
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Nagoya Y, Miyashita M, Shiwaku H. Pediatric Cancer Patients' Important End-of-Life Issues, Including Quality of Life: A Survey of Pediatric Oncologists and Nurses in Japan. J Palliat Med 2017; 20:487-493. [DOI: 10.1089/jpm.2016.0242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] 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
| | - Hitoshi Shiwaku
- Department of Child Health Nursing, Tohoku University School of Medicine, Miyagi, Japan
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123
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Still Searching: A Meta-Synthesis of a Good Death from the Bereaved Family Member Perspective. Behav Sci (Basel) 2017; 7:bs7020025. [PMID: 28441339 PMCID: PMC5485455 DOI: 10.3390/bs7020025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022] Open
Abstract
The concept of a good death continues to receive attention in end-of-life (EOL) scholarship. We sought to continue this line of inquiry related to a good death by conducting a meta-synthesis of published qualitative research studies that examined a good death from the bereaved family member's perspective. Results of the meta-synthesis included 14 articles with 368 participants. Based on analysis, we present a conceptual model called The Opportunity Model for Presence during the EOL Process. The model is framed in socio-cultural factors, and major themes include EOL process engagement with categories of healthcare participants, communication and practical issues. The second theme, (dis)continuity of care, includes categories of place of care, knowledge of family member dying and moment of death. Both of these themes lead to perceptions of either a good or bad death, which influences the bereavement process. We argue the main contribution of the model is the ability to identify moments throughout the interaction where family members can be present to the EOL process. Recommendations for healthcare participants, including patients, family members and clinical care providers are offered to improve the quality of experience throughout the EOL process and limitations of the study are discussed.
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124
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Hatano Y, Aoyama M, Morita T, Yamaguchi T, Maeda I, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. The relationship between cancer patients' place of death and bereaved caregivers' mental health status. Psychooncology 2017; 26:1959-1964. [PMID: 28345777 DOI: 10.1002/pon.4412] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although place of death has been recognized as a risk factor in caregivers' bereavement adjustment, the estimation of the effect of the place of death needs careful consideration about many potential cofounders. PATIENTS AND METHODS This study was a nationwide cross-sectional questionnaire survey for bereaved family caregivers of patients with cancer who died in 3 settings: (1) hospice at home; (2) palliative care units (PCUs); and (3) acute hospitals. We assessed bereaved caregivers' depression, grief, insomnia, and the quality of dying of deceased patients across the 3 groups using propensity score weighting. RESULTS A total of 8968 responses were analyzed. According to scores on Patient Health Questionnaire 9, depressive symptoms were significantly higher in bereaved caregivers of patients who had died in acute hospitals (5.7; 95% confidence interval [CI]: 5.3-6.2) than for those of patients who had died in hospice at home (4.8; 95% CI: 4.4-5.1) or PCU (5.1; 95% CI: 5.0-5.2). Grief symptoms measured by Brief Grief Questionnaire were also significantly higher in caregivers of patients who had died in acute hospitals (5.0; 95% CI: 4.8-5.2) than those of patients who had died in hospice at home (4.7; 95% CI: 4.5-4.9) or PCU (4.7; 95% CI: 4.7-4.8). Deceased patients' quality of dying was highest in hospice at home, and worst in acute hospital. CONCLUSIONS The place where a cancer patient dies influences not only their quality of dying and death but also the mental health of their family caregivers. However, the absolute difference is not large after adjustment of multiple variables.
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Affiliation(s)
- Yutaka Hatano
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Higashi-osaka, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Shizuoka, Hamamatsu, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, 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, Ibaraki, Tsukuba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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125
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Senda K, Nishikawa M, Goto Y, Miura H. Asian collaboration to establish a provisional system to provide high-quality end-of-life care by promoting advance care planning for older adults. Geriatr Gerontol Int 2017; 17:522-524. [DOI: 10.1111/ggi.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/11/2016] [Accepted: 07/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kazuyoshi Senda
- Department Home Care Promotion; National Center for Geriatrics and Gerontology; Obu Japan
| | - Mitsunori Nishikawa
- Department Home Care Promotion; National Center for Geriatrics and Gerontology; Obu Japan
| | - Yuko Goto
- Department Home Care Promotion; National Center for Geriatrics and Gerontology; Obu Japan
| | - Hisayuki Miura
- Department Home Care Promotion; National Center for Geriatrics and Gerontology; Obu Japan
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126
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Miyashita M, Aoyama M, Nakahata M, Yamada Y, Abe M, Yanagihara K, Shirado A, Shutoh M, Okamoto Y, Hamano J, Miyamoto A, Yoshida S, Sato K, Hirai K, Morita T. Development the Care Evaluation Scale Version 2.0: a modified version of a measure for bereaved family members to evaluate the structure and process of palliative care for cancer patient. BMC Palliat Care 2017; 16:8. [PMID: 28114917 PMCID: PMC5259912 DOI: 10.1186/s12904-017-0183-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 01/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Care Evaluation Scale (CES1.0) was designed to allow bereaved family members to evaluate the structure and process of care, but has been associated with a high frequency of misresponses. The objective of this study was to develop a modified version of CES1.0 (CES2.0) that would eliminate misresponses while maintaining good reliability and validity. METHODS We conducted a cross-sectional questionnaire survey by mail in October 2013. The participants were bereaved family members of patients who died from cancer in seven institutions in Japan. All family members were asked to complete CES2.0, the short form CES1.0, items on overall care satisfaction, the Family Satisfaction with Advanced Cancer Care (FAMCARE) Scale, the Patient Health Questionnaire-9 (PHQ-9) and the Brief Grief Questionnaire (BGQ). To examine test-retest reliability, all participants were asked to complete a second CES2.0. RESULTS Of 596 questionnaires sent, 461 (77%) were returned and 393 (66%) were analyzed. In the short form CES1.0, 17.1% of the responses were identified as misresponses. No misresponses were found in CES2.0. We identified 10 CES2.0 subscales similar to those in CES1.0 using exploratory factor analysis. Cronbach's alpha was 0.96, and the intraclass correlation coefficient was 0.83. Correlations were found between CES2.0 and overall satisfaction (r = 0.83) and FAMCARE (r = 0.58). In addition, total CES2.0 scores were negatively correlated with the PHQ-9 (r = -0.22) and BGQ (r = -0.10). CONCLUSION These results suggest that CES2.0 eliminated misresponses associated with CES1.0 while maintaining good reliability and validity and greatly improving test-retest reliability.
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Affiliation(s)
- Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan.
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | - Misato Nakahata
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | | | - Mutsumi Abe
- Department of Palliative Care and Pain Clinic, Matsue City Hospital, Matsue, Japan
| | - Kazuhiro Yanagihara
- Department of Medical Oncology, Kansai Electric Power Hospital, Osaka, Japan
| | - Akemi Shirado
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Mariko Shutoh
- Department of Palliative Medicine, Oita City Medical Association's Almeida Memorial Hospital, Oita, Japan.,Wata Clinic, Tokyo, Japan
| | - Yoshiaki Okamoto
- Department of Pharmacy, Ashiya Municipal Hospital, Ashiya, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Aoi Miyamoto
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | - Saki Yoshida
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | - Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | - Kei Hirai
- Institute of Academic Initiatives, & Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Shizuoka, Japan
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127
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Miyashita M, Aoyama M, Nakahata M, Yamada Y, Abe M, Yanagihara K, Shirado A, Shutoh M, Okamoto Y, Hamano J, Miyamoto A, Yoshida S, Sato K, Hirai K, Morita T. Development the Care Evaluation Scale Version 2.0: a modified version of a measure for bereaved family members to evaluate the structure and process of palliative care for cancer patient. BMC Palliat Care 2017. [PMID: 28114917 DOI: 10.1186/s12904‐017‐0183‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Care Evaluation Scale (CES1.0) was designed to allow bereaved family members to evaluate the structure and process of care, but has been associated with a high frequency of misresponses. The objective of this study was to develop a modified version of CES1.0 (CES2.0) that would eliminate misresponses while maintaining good reliability and validity. METHODS We conducted a cross-sectional questionnaire survey by mail in October 2013. The participants were bereaved family members of patients who died from cancer in seven institutions in Japan. All family members were asked to complete CES2.0, the short form CES1.0, items on overall care satisfaction, the Family Satisfaction with Advanced Cancer Care (FAMCARE) Scale, the Patient Health Questionnaire-9 (PHQ-9) and the Brief Grief Questionnaire (BGQ). To examine test-retest reliability, all participants were asked to complete a second CES2.0. RESULTS Of 596 questionnaires sent, 461 (77%) were returned and 393 (66%) were analyzed. In the short form CES1.0, 17.1% of the responses were identified as misresponses. No misresponses were found in CES2.0. We identified 10 CES2.0 subscales similar to those in CES1.0 using exploratory factor analysis. Cronbach's alpha was 0.96, and the intraclass correlation coefficient was 0.83. Correlations were found between CES2.0 and overall satisfaction (r = 0.83) and FAMCARE (r = 0.58). In addition, total CES2.0 scores were negatively correlated with the PHQ-9 (r = -0.22) and BGQ (r = -0.10). CONCLUSION These results suggest that CES2.0 eliminated misresponses associated with CES1.0 while maintaining good reliability and validity and greatly improving test-retest reliability.
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Affiliation(s)
- Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan.
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | - Misato Nakahata
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | | | - Mutsumi Abe
- Department of Palliative Care and Pain Clinic, Matsue City Hospital, Matsue, Japan
| | - Kazuhiro Yanagihara
- Department of Medical Oncology, Kansai Electric Power Hospital, Osaka, Japan
| | - Akemi Shirado
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Mariko Shutoh
- Department of Palliative Medicine, Oita City Medical Association's Almeida Memorial Hospital, Oita, Japan.,Wata Clinic, Tokyo, Japan
| | - Yoshiaki Okamoto
- Department of Pharmacy, Ashiya Municipal Hospital, Ashiya, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Aoi Miyamoto
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | - Saki Yoshida
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | - Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, 980-8575, Sendai, Japan
| | - Kei Hirai
- Institute of Academic Initiatives, & Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Shizuoka, Japan
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128
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Sato K, Kikuchi A, Miyashita M, Kinoshita H. Good Death of Dying Elderly Patients with and without Comorbid Dementia from the Perspective of Bereaved Family Members. ACTA ACUST UNITED AC 2017. [DOI: 10.2512/jspm.12.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine
- Department of Nursing, School of Health Sciences, Nagoya University Graduate School of Medicine
| | - Arisa Kikuchi
- Health Sciences, Tohoku University School of Medicine
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine
| | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital East
- Department of Palliative Care, Tokatsu Hospital
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129
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Shaku F, Tsutsumi M. The Effect of Providing Life Support on Nurses’ Decision Making Regarding Life Support for Themselves and Family Members in Japan. Am J Hosp Palliat Care 2016; 33:917-923. [DOI: 10.1177/1049909115624655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Decision making in terminal illness has recently received increased attention. In Japan, patients and their families typically make decisions without understanding either the severity of illness or the efficacy of life-supporting treatments at the end of life. Japanese culture traditionally directs the family to make decisions for the patient. This descriptive study examined the influence of the experiences of 391 Japanese nurses caring for dying patients and family members and how that experience changed their decision making for themselves and their family members. The results were mixed but generally supported the idea that the more experience nurses have in caring for the dying, the less likely they would choose to institute lifesupport measures for themselves and family members. The results have implications for discussions on end-of-life care.
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Affiliation(s)
- Fumio Shaku
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Madoka Tsutsumi
- Primary Care and Medical Education, University of Tsukuba, Ibaraki, Japan
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130
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Morita T, Naito AS, Aoyama M, Ogawa A, Aizawa I, Morooka R, Kawahara M, Kizawa Y, Shima Y, Tsuneto S, Miyashita M. Nationwide Japanese Survey About Deathbed Visions: "My Deceased Mother Took Me to Heaven". J Pain Symptom Manage 2016; 52:646-654.e5. [PMID: 27660082 DOI: 10.1016/j.jpainsymman.2016.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/17/2016] [Accepted: 04/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Primary aim was to clarify the prevalence and factors associated with the occurrence of deathbed visions, explore associations among deathbed visions, a good death, and family depression. Additional aim was to explore the emotional reaction, perception, and preferred clinical practice regarding deathbed visions from the view of bereaved family members. METHODS A nationwide questionnaire survey was conducted involving 3964 family members of cancer patients who died at hospitals, palliative care units, and home. RESULTS A total of 2827 responses (71%) were obtained, and finally 2221 responses were analyzed. Deathbed visions were reported in 21% (95% CIs, 19-23; n = 463). Deathbed visions were significantly more likely to be observed in older patients, female patients, female family members, family members other than spouses, more religious families, and families who believed that the soul survives the body after death. Good death scores for the patients were not significantly different between the families who reported that the patients had experienced deathbed visions and those who did not, whereas depression was more frequently observed in the former than latter, with marginal significance (20 vs. 16%, respectively, adjusted P = 0.068). Although 35% of the respondents agreed that deathbed visions were hallucinations, 38% agreed that such visions were a natural and transpersonal phenomenon in the dying process; 81% regarded it as necessary or very necessary for clinicians to share the phenomenon neutrally, not automatically labeling them as medically abnormal. CONCLUSIONS Deathbed vision is not an uncommon phenomenon. Clinicians should not automatically regard such visions as an abnormal phenomenon to be medically treated and rather provide an individualized approach.
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Affiliation(s)
- Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
| | - Akemi Shirado Naito
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Asao Ogawa
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Izuru Aizawa
- Soshukai Research Institute, Natori, Miyagi, Japan
| | - Ryosuke Morooka
- Faculty of Education, Shimane University, Matsue, Shimane, Japan
| | | | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Foundation, Home Care Service, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Palliative Care Center, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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131
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Maeda I, Miyashita M, Yamagishi A, Kinoshita H, Shirahige Y, Izumi N, Yamaguchi T, Igarashi M, Kato M, Morita T. Changes in Relatives' Perspectives on Quality of Death, Quality of Care, Pain Relief, and Caregiving Burden Before and After a Region-Based Palliative Care Intervention. J Pain Symptom Manage 2016; 52:637-645. [PMID: 27664834 DOI: 10.1016/j.jpainsymman.2016.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 03/09/2016] [Accepted: 05/20/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT A region-based palliative care intervention (Outreach Palliative Care Trial of Integrated Regional Model Study) increased home death, access to specialist palliative care, quality of care, and quality of death and dying. OBJECTIVES The objective of this study was to examine changes in palliative care outcomes in different care settings (hospitals, palliative care units, and home) and obtain insights into how to improve region-level palliative care. METHODS The intervention program was implemented from April 2008 to March 2011. Two bereavement surveys were conducted before and after intervention involving 4228 family caregivers of deceased cancer patients. Family-perceived quality of care (range 1-6), quality of death and dying (1-7), pain relief (1-7), and caregiver burden (1-7) were measured. RESULTS Response rates were 69% (preintervention) and 66% (postintervention), respectively. Family-perceived quality of care (adjusted mean 4.89, 95% CI 4.54-5.23) and quality of death and dying (4.96, 4.72-5.20) at home were the highest and sustained throughout the study. Palliative care units were at the intermediate level between home and hospitals. In hospitals, both quality of care and quality of death and dying were low at baseline but significantly improved after intervention (quality of care: 4.24, 4.13-4.34 to 4.43, 4.31-4.54, P = 0.002; quality of death and dying: 4.22, 4.09-4.36 to 4.36, 4.22-4.50, P = 0.012). Caregiver burden did not significantly increase after intervention, regardless of place of death. CONCLUSIONS The dual strategies of transition of place of death to home and improving quality of care in hospitals should be recognized as important targets for improving region-level palliative care.
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Affiliation(s)
- Isseki Maeda
- Department of Palliative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akemi Yamagishi
- Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwashi, Chiba, Japan
| | | | - Noriko Izumi
- Department of Internal Medicine and Palliative Care Team, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Miyuki Igarashi
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Kato
- Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
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132
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Aoyama M, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. The Japan HOspice and Palliative Care Evaluation Study 3: Study Design, Characteristics of Participants and Participating Institutions, and Response Rates. Am J Hosp Palliat Care 2016; 34:654-664. [DOI: 10.1177/1049909116646336] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article describes the whole picture of Japan HOspice and Palliative Care Evaluation Study 3 (J-HOPE3 Study) including study design and demographic data. The aims of the J-HOPE3 study were to (1) evaluate the process, structure, and outcome of palliative care in the following care settings: acute hospitals, inpatient hospice/palliative care units (PCUs), and home hospice services; (2) examine bereaved family members’ self-reported psychosocial conditions, such as grief and depression, as bereavement outcomes; (3) provide data to ensure and improve the quality of care provided by participating institutions through feedback concerning results for each institution; and (4) perform additional studies to explore specific clinical research questions. We conducted a cross-sectional, anonymous, self-report questionnaire survey involving patients’ bereaved family members in 20 acute hospitals, 133 PCUs, and 22 home hospice services between May and July 2014. Two types of questionnaires were used: main and specific studies questionnaires. The questionnaire was sent to totally 13 584, and 10 157 returned the questionnaire. The analysis included 9126 family members’ questionnaires from acute hospitals, PCUs, and home hospice services. Respondents’ average age was 61.6 years, 55% were women, and 40% had been married to the deceased. With respect to the characteristics of participating institutions, most institutions did not have religious affiliations, and most PCUs and home hospice services provided bereavement care. These results of the analysis of common and additional questionnaires could play an important role in clinical settings, quality improvement, research, and public accountability.
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Affiliation(s)
- Maho Aoyama
- Department of Community Health, Health Sciences, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Palliative Care Team, Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Kita-ku, Hamamtsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Palliative Care Center, Kyoto University Hospital, Shogoin, Saikyo-ku, Kyoto, Japan
| | - Yasuo Shima
- Home Care Service, Department of Palliative Medicine, Tsukuba Medical Center Foundation, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan
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133
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Igarashi A, Miyashita M, Morita T, Akizuki N, Akiyama M, Shirahige Y, Sato K, Yamamoto-Mitani N, Eguchi K. Association Between Bereaved Families' Sense of Security and Their Experience of Death in Cancer Patients: Cross-Sectional Population-Based Study. J Pain Symptom Manage 2016; 51:926-32. [PMID: 26706626 DOI: 10.1016/j.jpainsymman.2015.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 11/24/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
CONTEXT The sense of security scale was developed to indicate care quality within the community. Bereaved families have perspective to evaluate the quality of the care system. OBJECTIVES The aim was to examine associations between end-of-life care and sense of security regarding regional cancer care among bereaved families. METHODS A cross-sectional population-based survey was conducted with families of cancer patients who died in regional areas of Japan. RESULTS A total of 1046 family caregivers of patients responded to surveys (effective response rate of 65%). In multiple regression analyses, the families' higher age (P < 0.001), home death (P = 0.039), better health status of the family at patients' end of life (P = 0.016), lower caregiving burden (P < 0.001), and elements of perceived good patient death, including being free from physical distress (P < 0.001), trusting the physician (P < 0.001), living in calm circumstances (P = 0.042), and feeling that one's life was fulfilling (P = 0.035), were associated with a higher sense of security. CONCLUSION Quality of death and lower burden on family caregivers were associated with families' sense of security. This suggests strategies for improving care quality for each patient to improve the sense of security.
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Affiliation(s)
- Ayumi Igarashi
- Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Graduate School of Tohoku University, Sendai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Nobuya Akizuki
- Psycho-Oncology Division, Chiba Cancer Center, Chiba, Japan
| | - Miki Akiyama
- Faculty of Environment and Information Studies, Keio University, Tokyo, Japan
| | | | - Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Graduate School of Tohoku University, Sendai, Japan
| | - Noriko Yamamoto-Mitani
- Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Eguchi
- Department of Internal Medicine and Medical Oncology, Teikyo University School of Medicine, Tokyo, Japan
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134
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Cornally N, Coffey A, Daly E, McGlade C, Weathers E, O’Herlihy E, O’Caoimh R, McLoughlin K, Svendrovski A, Molloy W. Measuring staff perception of end-of-life experience of older adults in long-term care. Appl Nurs Res 2016; 30:245-51. [DOI: 10.1016/j.apnr.2015.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/14/2015] [Accepted: 05/20/2015] [Indexed: 11/30/2022]
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135
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Jho HJ, Choi JY, Kwak KS, Chang YJ, Ahn EM, Park EJ, Paek SJ, Kim KM, Kim SH. Prevalence and Associated Factors of Anxiety and Depressive Symptoms Among Bereaved Family Members of Cancer Patients in Korea: A Nation-Wide Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3716. [PMID: 27258497 PMCID: PMC4900705 DOI: 10.1097/md.0000000000003716] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Bereaved family members of cancer patient are at risk of having psychological problems such as anxiety and depression. However, prevalence and associated factors of anxiety and depressive symptoms among this population have not been explored in Korea.We conducted a nation-wide cross-sectional questionnaire survey of 3522 bereaved family members of cancer patients who died at 44 hospice palliative care unit (HPCU) in Korea in 2012. The questionnaire comprised the Hospital Anxiety and Depression Scale (HADS) and Good Death Inventory (GDI). Deceased patient's age, sex, primary site of cancer, duration of stay at HPCU, awareness of terminal status, bereaved family member's age, sex, and relation to the deceased were collected from Korean Terminal Cancer Patients Information System.1121 returned questionnaires were analyzed (response rate, 31.8%). Using a cut-off value of 8 for HADS subscale, the prevalence of anxiety and depressive symptoms was 48.0% and 57.6%, respectively. Mean scores for HADS-A and HADS-D were 7.88 ± 4.87 and 8.91 ± 4.82, respectively. Among the bereaved, older age, being a spouse to the deceased, family members of younger patient, and negative score for a few GDI items were significantly associated with an increased risk of having anxiety or depressive symptoms in the multivariate logistic analysis.In conclusion, we noted the high prevalence of anxiety and depressive symptoms among the bereaved of cancer patients and identified associated factors for these psychological morbidities. Systematic efforts are needed to improve the mental health of the bereaved family members of cancer patients.
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Affiliation(s)
- Hyun Jung Jho
- From the Palliative Care Clinic, Hospital (HJJ), Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang (HJJ, JYC, KSK, YJC, EMA, EJP, SJP, KMK), and Department of Nursing (SHK), Inha University, Incheon, Republic of Korea
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136
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Nakazawa Y, Kato M, Yoshida S, Miyashita M, Morita T, Kizawa Y. Population-Based Quality Indicators for Palliative Care Programs for Cancer Patients in Japan: A Delphi Study. J Pain Symptom Manage 2016; 51:652-661. [PMID: 26674609 DOI: 10.1016/j.jpainsymman.2015.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/27/2022]
Abstract
CONTEXT Cancer control programs in Japan strongly endorse the dissemination of palliative care, and various policy measures have been implemented; however, indicators for evaluating palliative care programs have not been defined. OBJECTIVES The aim of this study was to develop quality indicators for palliative care programs taking a population-based view to meet the challenge of cancer control in the Japanese population. METHODS We conducted a modified Delphi survey. The panelists rated a list of indicators over three iterative rounds according to four perspectives: 1) consistency with the policy target, 2) relevance to the problem, 3) clarity of expression, and 4) measurement feasibility. The criterion for adoption of candidate indicators was set at a total mean score of 7 or more. Finally, the most relevant and important indicators were selected; consensus was defined by agreement of panelists at the panel meeting. RESULTS Among 49 panelists surveyed, 48 (98%), 39 (80%), and 43 (88%) responded over the three rounds, respectively. The 15 indicators were identified from 11 domains: patient-reported quality of life, bereaved family-reported quality at the end of life, family care, place of death, bereaved family-reported quality of palliative care, specialized palliative care services, opioid utilization, public perceptions about palliative care, palliative care education to primary care providers, specialist palliative care services, and regional palliative care. CONCLUSION Comprehensive quality indicators for palliative care programs were identified. The indicators are currently being used, and the feasibility of measuring change over time will be examined. It is expected that the indicators will be used effectively in the future. It is important to evaluate outcomes of the program, to improve weaknesses, improve outcomes, and promote the welfare of cancer patients.
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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.
| | - Masahi Kato
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Saran Yoshida
- 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
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Division of Palliative Medicine, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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137
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Meier EA, Gallegos JV, Thomas LPM, Depp CA, Irwin SA, Jeste DV. Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue. Am J Geriatr Psychiatry 2016; 24:261-71. [PMID: 26976293 PMCID: PMC4828197 DOI: 10.1016/j.jagp.2016.01.135] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 12/18/2015] [Accepted: 01/19/2016] [Indexed: 12/15/2022]
Abstract
There is little agreement about what constitutes good death or successful dying. The authors conducted a literature search for published, English-language, peer-reviewed reports of qualitative and quantitative studies that provided a definition of a good death. Stakeholders in these articles included patients, prebereaved and bereaved family members, and healthcare providers (HCPs). Definitions found were categorized into core themes and subthemes, and the frequency of each theme was determined by stakeholder (patients, family, HCPs) perspectives. Thirty-six studies met eligibility criteria, with 50% of patient perspective articles including individuals over age 60 years. We identified 11 core themes of good death: preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with HCP, and other. The top three themes across all stakeholder groups were preferences for dying process (94% of reports), pain-free status (81%), and emotional well-being (64%). However, some discrepancies among the respondent groups were noted in the core themes: Family perspectives included life completion (80%), quality of life (70%), dignity (70%), and presence of family (70%) more frequently than did patient perspectives regarding those items (35%-55% each). In contrast, religiosity/spirituality was reported somewhat more often in patient perspectives (65%) than in family perspectives (50%). Taking into account the limitations of the literature, further research is needed on the impact of divergent perspectives on end-of-life care. Dialogues among the stakeholders for each individual must occur to ensure a good death from the most critical viewpoint-the patient's.
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Affiliation(s)
- Emily A Meier
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Patient & Family Support Services, University of California, San Diego, La Jolla, CA
| | - Jarred V Gallegos
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Patient & Family Support Services, University of California, San Diego, La Jolla, CA
| | - Lori P Montross Thomas
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Patient & Family Support Services, University of California, San Diego, La Jolla, CA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Colin A Depp
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA
| | - Scott A Irwin
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Patient & Family Support Services, University of California, San Diego, La Jolla, CA
| | - Dilip V Jeste
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA.
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138
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A systematic review of instruments assessing dimensions of distress among caregivers of adult and pediatric cancer patients. Palliat Support Care 2016; 15:110-124. [DOI: 10.1017/s1478951516000079] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AbstractObjective:Caregivers of cancer patients face intense demands throughout the course of the disease, survivorship, and bereavement. Caregiver burden, needs, satisfaction, quality of life, and other significant areas of caregiving are not monitored regularly in the clinic setting, resulting in a need to address the availability and clinical effectiveness of cancer caregiver distress tools. This review aimed to determine the availability of cancer caregiver instruments, the variation of instruments between different domains of distress, and that between adult and pediatric cancer patient populations.Method:A literature search was conducted using various databases from 1937 to 2013. Original articles on instruments were extracted separately if not included in the original literature search. The instruments were divided into different areas of caregiver distress and into adult versus pediatric populations. Psychometric data were also evaluated.Results:A total of 5,541 articles were reviewed, and 135 articles (2.4%) were accepted based on our inclusion criteria. Some 59 instruments were identified, which fell into the following categories: burden (n = 26, 44%); satisfaction with healthcare delivery (n = 5, 8.5%); needs (n = 14, 23.7%); quality of life (n = 9, 15.3%); and other issues (n = 5, 8.5%). The median number of items was 29 (4–125): 20/59 instruments (33.9%) had ≤20 items; 13 (22%) had ≤20 items and were psychometrically sound, with 12 of these 13 (92.3%) being self-report questionnaires. There were 44 instruments (74.6%) that measured caregiver distress for adult cancer patients and 15 (25.4%) for caregivers of pediatric patients.Significance of results:There is a significant number of cancer caregiver instruments that are self-reported, concise, and psychometrically sound, which makes them attractive for further research into their clinical use, outcomes, and effectiveness.
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139
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Chen HP, Huang BY, Yi TW, Deng YT, Liu J, Zhang J, Wang YQ, Zhang ZY, Jiang Y. Attitudes of Chinese Oncology Physicians Toward Death with Dignity. J Palliat Med 2016; 19:874-8. [PMID: 27022774 PMCID: PMC4982948 DOI: 10.1089/jpm.2015.0344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Death with dignity (DWD) refers to the refusal of life-prolonging measures for terminally ill patients by "living wills" forms in advance. More and more oncology physicians are receiving DWD requests from advance cancer patients in mainland China. OBJECTIVE The study objective was to investigate the attitudes of Chinese oncology physicians toward the legalization and implementation of DWD. METHODS A questionnaire investigating the understanding and attitudes toward DWD was administered to 257 oncology physicians from 11 hospitals in mainland China. RESULTS The effective response rate was 86.8% (223/257). The majority of oncology physicians (69.1%) had received DWD requests from patients. Half of the participants (52.5%) thought that the most important reason was the patients' unwillingness to maintain survival through machines. One-third of participants (33.0%) attributed the most important reason to suffering from painful symptoms. Most oncology physicians (78.9%) had knowledge about DWD. A fifth of respondents did not know the difference between DWD and euthanasia, and a few even considered DWD as euthanasia. The majority of oncology physicians supported the legalization (88.3%) and implementation (83.9%) of DWD. CONCLUSIONS Many Chinese oncology physicians have received advanced cancer patients' DWD requests and think that DWD should be legalized and implemented. Chinese health management departments should consider the demands of physicians and patients. It is important to inform physicians about the difference between DWD and euthanasia, as one-fifth of them were confused about it.
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Affiliation(s)
- Hui-Ping Chen
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, People's Republic of China .,2 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University , Chengdu, People's Republic of China
| | - Bo-Yan Huang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, People's Republic of China
| | - Ting-Wu Yi
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, People's Republic of China
| | - Yao-Tiao Deng
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, People's Republic of China
| | - Jie Liu
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, People's Republic of China
| | - Jie Zhang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, People's Republic of China
| | - Yu-Qing Wang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, People's Republic of China
| | - Zong-Yan Zhang
- 3 Dehong Hospice, Dehong People's Hospital , Yunnan, People's Republic of China
| | - Yu Jiang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University , Chengdu, People's Republic of China
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141
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Miyashita M, Wada M, Morita T, Ishida M, Onishi H, Tsuneto S, Shima Y. Development and validation of the Comprehensive Quality of Life Outcome (CoQoLo) inventory for patients with advanced cancer. BMJ Support Palliat Care 2015; 9:75-83. [PMID: 26497747 DOI: 10.1136/bmjspcare-2014-000725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/16/2015] [Accepted: 09/16/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of this study was to develop a scale capable of measuring comprehensive quality of life (QOL) outcomes based on the concept of a good death for patients with advanced cancer. METHODS We conducted an anonymous cross-sectional questionnaire survey on inpatients being treated at the Oncology Clinic in Saitama Medical University International Medical Center and seven palliative units throughout Japan. RESULTS A total of 405 patients with cancer participated in this study. Factor analysis of scores on the Comprehensive Quality of Life Outcome (CoQoLo) inventory revealed 28 items and the following 10 subscales: physical and psychological comfort; staying in a favourite place; maintaining hope and pleasure; good relationships with medical staff; not being a burden to others; good relationships with family; independence; environmental comfort; being respected as an individual; and having a fulfilling life. The total CoQoLo score was moderately correlated with satisfaction (r=0.34) and overall QOL (r=0.34), and moderately correlated with feelings of support and security regarding cancer care (r=0.44). Cronbach's α and the intraclass correlation coefficient of the total score were 0.90 and 0.79, respectively. No significant correlation was found between the total CoQoLo score and self-reported Eastern Cooperative Oncology Group performance status (r=-0.01). CONCLUSIONS These results suggest that the CoQoLo has sufficient reliability and validity and therefore provides an accurate measure of QOL outcomes independent of the general physical condition of the patient.
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Affiliation(s)
- Mitsunori Miyashita
- Department of Adult Nursing/Palliative Care Nursing, Graduate School of Health Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Makoto Wada
- Department of Psycho-oncology and Palliative Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu City, Japan
| | - Mayumi Ishida
- Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideki Onishi
- Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
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142
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Shin DW, Lee JE, Cho B, Yoo SH, Kim S, Yoo JH. End-of-life communication in Korean older adults: With focus on advance care planning and advance directives. Geriatr Gerontol Int 2015; 16:407-15. [DOI: 10.1111/ggi.12603] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior; Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
- JW Lee Center for Global Medicine; College of Medicine; Seoul National University; Seoul Korea
| | - Ji Eun Lee
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
| | - BeLong Cho
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior; Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
- Institute on Aging; Seoul National University College of Medicine; Seoul Korea
- Advanced Institutes of Convergence Technology; Seoul National University; Gyeonggi-do Korea
| | - Sang Ho Yoo
- Department of Medical Education; College of Medicine; Hanyang University; Seoul Korea
| | - SangYun Kim
- Department of Neurology; Seoul National University College of Medicine & Seoul National University Bundang Hospital; Seoul Korea
| | - Jun-Hyun Yoo
- Department of Family Medicine; Sungkyunkwan University College of Medicine & Samsung Medical Center; Seoul Korea
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143
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Hatano Y, Fujimoto S, Hosokawa T, Fukui K. Association Between "Good Death" of Cancer Patients and Post-Traumatic Growth in Bereaved Caregivers. J Pain Symptom Manage 2015; 50:e4-6. [PMID: 26025272 DOI: 10.1016/j.jpainsymman.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/01/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Yutaka Hatano
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Sawako Fujimoto
- Department of Pain Management & Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toyoshi Hosokawa
- Department of Pain Management & Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Fukui
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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144
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Morita T, Oyama Y, Cheng SY, Suh SY, Koh SJ, Kim HS, Chiu TY, Hwang SJ, Shirado A, Tsuneto S. Palliative Care Physicians' Attitudes Toward Patient Autonomy and a Good Death in East Asian Countries. J Pain Symptom Manage 2015; 50:190-9.e1. [PMID: 25827851 DOI: 10.1016/j.jpainsymman.2015.02.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/30/2015] [Accepted: 02/14/2015] [Indexed: 11/20/2022]
Abstract
CONTEXT Clarification of the potential differences in end-of-life care among East Asian countries is necessary to provide palliative care that is individualized for each patient. OBJECTIVES The aim was to explore the differences in attitude toward patient autonomy and a good death among East Asian palliative care physicians. METHODS A cross-sectional survey was performed involving palliative care physicians in Japan, Taiwan, and Korea. Physicians' attitudes toward patient autonomy and physician-perceived good death were assessed. RESULTS A total of 505, 207, and 211 responses were obtained from Japanese, Taiwanese, and Korean physicians, respectively. Japanese (82%) and Taiwanese (93%) physicians were significantly more likely to agree that the patient should be informed first of a serious medical condition than Korean physicians (74%). Moreover, 41% and 49% of Korean and Taiwanese physicians agreed that the family should be told first, respectively; whereas 7.4% of Japanese physicians agreed. Physicians' attitudes with respect to patient autonomy were significantly correlated with the country (Japan), male sex, physician specialties of surgery and oncology, longer clinical experience, and physicians having no religion but a specific philosophy. In all 12 components of a good death, there were significant differences by country. Japanese physicians regarded physical comfort and autonomy as significantly more important and regarded preparation, religion, not being a burden to others, receiving maximum treatment, and dying at home as less important. Taiwanese physicians regarded life completion and being free from tubes and machines as significantly more important. Korean physicians regarded being cognitively intact as significantly more important. CONCLUSION There are considerable intercountry differences in physicians' attitudes toward autonomy and physician-perceived good death. East Asia is not culturally the same; thus, palliative care should be provided in a culturally acceptable manner for each country.
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Affiliation(s)
- Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan.
| | - Yasuhiro Oyama
- Division of Clinical Psychology, Kyoto University, Kyoto, Japan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, South Korea
| | - Su Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Hyun Sook Kim
- Department of Social Welfare, Korea National University of Transportation, Chungju City, South Korea
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Akemi Shirado
- Palliative Care Team, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Satoru Tsuneto
- Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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145
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Cheng SY, Lin WY, Cheng YH, Huang CH, Chen CY, Hwang SJ, Tsai ST, Chiu TY. Cancer patient autonomy and quality of dying-a prospective nationwide survey in Taiwan. Psychooncology 2015; 25:179-86. [DOI: 10.1002/pon.3901] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/21/2015] [Accepted: 06/11/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital; National Taiwan University; Taipei Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine; China Medical University Hospital; Taichung Taiwan
- School of Medicine; China Medical University; Taichung Taiwan
| | - Ya-Hui Cheng
- Department of Family Medicine, Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Chien Hsiun Huang
- Department of Community and Family Medicine; National Taiwan University Hospital Yun-Lin Branch; Yun-Lin Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine, College of Medicine and Hospital; National Taiwan University; Taipei Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Shih-Tzu Tsai
- Center for Preventive Service, Hualien Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; Hualien Taiwan
- College of Medicine; Tzu Chi University; Hualien Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital; National Taiwan University; Taipei Taiwan
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Miyashita M, Morita T, Sato K, Tsuneto S, Shima Y. A Nationwide Survey of Quality of End-of-Life Cancer Care in Designated Cancer Centers, Inpatient Palliative Care Units, and Home Hospices in Japan: The J-HOPE Study. J Pain Symptom Manage 2015; 50:38-47.e3. [PMID: 25656327 DOI: 10.1016/j.jpainsymman.2015.01.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/28/2014] [Accepted: 01/07/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT End-of-life (EOL) cancer care in general hospitals and home care has not previously been evaluated in Japan. OBJECTIVES This study aimed to evaluate EOL cancer care from the perspective of bereaved family members in nationwide designated cancer centers, inpatient palliative care units (PCUs), and home hospices in Japan. METHODS We conducted a cross-sectional, anonymous, self-report questionnaire survey for bereaved family members of cancer patients in March 2008 for 56 designated cancer centers and in June 2007 for 100 PCUs and 14 home hospices. Outcomes were overall care satisfaction, structure and process of care (Care Evaluation Scale), and achievement of a good death (Good Death Inventory). RESULTS In designated cancer centers, PCUs, and home hospices, 2794 (response rate 59%), 5312 (response rate 69%), and 292 (response rate 67%) bereaved family members participated, respectively. Mean scores for overall care satisfaction were high for all places of death, at 4.3 ± 1.2 for designated cancer centers, 5.0 ± 1.2 for PCUs, and 5.0 ± 1.0 for home hospices. Designated cancer centers showed significantly lower ratings than PCUs and home hospices for structure and process of care and achievement of a good death (P = 0.0001 each). Home hospices were rated significantly higher than PCUs for achievement of a good death (P = 0.0001). CONCLUSION The main findings of this study were: (1) overall, bereaved family members were satisfied with end-of-life care in all three places of death; (2) designated cancer centers were inferior to PCUs and home hospices and had more room for improvement; and 3) home hospices were rated higher than PCUs for achieving a good death, although home hospices remain uncommon in Japan.
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Affiliation(s)
- Mitsunori Miyashita
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing Sciences, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan; Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Kazuki Sato
- Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing Sciences, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan; Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
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147
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Lendon JP, Ahluwalia SC, Walling AM, Lorenz KA, Oluwatola OA, Anhang Price R, Quigley D, Teno JM. Measuring Experience With End-of-Life Care: A Systematic Literature Review. J Pain Symptom Manage 2015; 49:904-15.e1-3. [PMID: 25543110 PMCID: PMC5063029 DOI: 10.1016/j.jpainsymman.2014.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/27/2014] [Accepted: 10/22/2014] [Indexed: 11/25/2022]
Abstract
CONTEXT Increasing interest in end-of-life care has resulted in many tools to measure the quality of care. An important outcome measure of end-of-life care is the family members' or caregivers' experiences of care. OBJECTIVES To evaluate the instruments currently in use to inform next steps for research and policy in this area. METHODS We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS(®) for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care. Survey items were abstracted and categorized into content areas identified through an iterative method using three independent reviewers. We also abstracted information from the most frequently used surveys about the identification of proxy respondents for after-death surveys, the timing and method of survey administration, and the health care setting being assessed. RESULTS We identified 88 articles containing 51 unique surveys with available content. We characterized 14 content areas variably present across the 51 surveys. Information and care planning, provider care, symptom management, and overall experience were the most frequent areas addressed. There was also considerable variation across the surveys in the identification of proxy respondents, the timing of survey administration, and in the health care settings and services being evaluated. CONCLUSION This review identified several comprehensive surveys aimed at measuring the experiences of end-of-life care, covering a variety of content areas and practical issues for survey administration. Future work should focus on standardizing surveys and administration methods so that experiences of care can be reliably measured and compared across care settings.
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Affiliation(s)
| | | | - Anne M Walling
- VA Greater Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA; RAND Corporation, Santa Monica, California, USA
| | - Karl A Lorenz
- VA Greater Los Angeles, Los Angeles, California, USA
| | | | | | | | - Joan M Teno
- Brown University, Providence, Rhode Island, USA
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148
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Perceived timeliness of referral to hospice palliative care among bereaved family members in Korea. Support Care Cancer 2015; 23:2805-11. [PMID: 25739751 DOI: 10.1007/s00520-015-2646-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We aimed to explore the perceived timeliness of referral to hospice palliative care unit (HPCU) among bereaved family members in Korea and factors associated therewith. METHODS Cross-sectional questionnaire survey was performed for bereaved family members of patients who utilized 40 designated HPCUs across Korea. The questionnaire assessed whether admission to the HPCU was "too late" or "appropriate" and the Good Death Inventory (GDI). RESULTS A total of 383 questionnaires were analyzed. Of participants, 25.8 % replied that admission to HPCU was too late. Patients with hepatobiliary cancer, poor performance status, abnormal consciousness level, and unawareness of terminal status were significantly related with the too late perception. Family members with younger age and being a child of the patient were more frequently noted in the too late group. Ten out of 18 GDI scores were significantly lower in the too late group. Multiple logistic regression analysis revealed patients' unawareness of terminal status, shorter stay in the HPCU, younger age of bereaved family, and lower scores for two GDI items (staying in a favored place, living without concerning death or disease) were significantly associated with the too late group. CONCLUSIONS To promote timely HPCU utilization and better quality of end of life care, patients need to be informed of the terminal status and their preference should be respected.
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Dempsey L, Dowling M, Larkin P, Murphy K. The unmet palliative care needs of those dying with dementia. Int J Palliat Nurs 2015; 21:126-33. [DOI: 10.12968/ijpn.2015.21.3.126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laura Dempsey
- Lecturer and Programme Director for the Postgraduate Diploma in Nursing (Palliative Care)
| | - Maura Dowling
- Lecturer and Programme Director for Masters Programmes in the School of Nursing and Midwifery, both at National University of Ireland, Galway, Ireland
| | - Philip Larkin
- Associate Professor of Clinical Nursing (Palliative Care) at the School of Nursing, Midwifery and Health Systems, University College Dublin and at Our Lady's Hospice, Ireland
| | - Kathy Murphy
- Lecturer and Professor of Nursing, School of Nursing and Midwifery University of Ireland, Galway, Ireland
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Kinoshita H, Maeda I, Morita T, Miyashita M, Yamagishi A, Shirahige Y, Takebayashi T, Yamaguchi T, Igarashi A, Eguchi K. Place of Death and the Differences in Patient Quality of Death and Dying and Caregiver Burden. J Clin Oncol 2015; 33:357-63. [DOI: 10.1200/jco.2014.55.7355] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose To explore the associations between place of death and quality of death and dying and caregiver burden in terminally ill patients with cancer and their families. Methods Two bereavement surveys were conducted in October 2008 and October 2011. A total of 2,247 family caregivers of patients with cancer who were deceased responded to the mail surveys (response rate, 67%). Family members reported patient quality of death and dying and caregiver burden by using the Good Death Inventory and Caregiving Consequences Inventory. Results Patient quality of death and dying was significantly higher at home relative to other places of dying after adjustment for patient and/or family characteristics (adjusted means): 5.0 (95% CI, 4.9 to 5.2) for home, 4.6 (95% CI, 4.5 to 4.7) for palliative care units, and 4.3 (95% CI, 4.2 to 4.4) for hospitals. For all combinations, pairwise P < .001; the size of the difference between home and hospital was moderate (Hedges' g, 0.45). Home was superior to palliative care units or hospitals with respect to “dying in a favorite place,” “good relationships with medical staff,” “good relationships with family,” and “maintaining hope and pleasure” (P < .001 for all combinations of home v palliative care units and home v hospitals). Home death was significantly associated with a lower overall (P = .03) and financial caregiver burden (P = .004) relative to hospital death. Conclusion Dying at home may contribute to achieving good death in terminally ill patients with cancer without causing remarkably increased caregiver burden. Place of death should be regarded as an essential goal in end-of-life care.
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Affiliation(s)
- Hiroya Kinoshita
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Isseki Maeda
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Tatsuya Morita
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Mitsunori Miyashita
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Akemi Yamagishi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Yutaka Shirahige
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Toru Takebayashi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Takuhiro Yamaguchi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Ayumi Igarashi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Kenji Eguchi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
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