Talking About Death With Terminally-Ill Cancer Patients: What Contributes to the Regret of Bereaved Family Members?
Talking About Death With Terminally-Ill Cancer Patients: What Contributes to the Regret of Bereaved Family Members?
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DOI：
10.1016/j.jpainsymman.2017.02.021
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发表时间：
2017-12-01
影响因子：
4.7
通讯作者：
Miyashita, Mitsunori
中科院分区：
文献类型：
--
作者：
Mori, Masanori;Yoshida, Saran;Miyashita, Mitsunori
上下文谈论死亡是癌症晚期患者及其家人的一个重要问题。很少有人知道有多少次，哪些丧亲家庭后悔没有和他们已故的亲人谈论死亡。探讨成年癌症患者的丧亲家属中没有与已故亲人谈论死亡的遗憾的患病率，并系统地探讨导致他们遗憾的因素。我们在日本全国范围内对133家住院临终关怀医院的999名癌症患者家属进行了调查，并调查了家属对谈论死亡的遗憾。探索性分析确定的过程，选项和结果分量表的因素，导致后悔的基本结构。在678个丧亲家庭中（回应率68%），224个（33%）后悔没有充分谈论死亡，40个（5.9%）相反后悔谈论了死亡。三个工艺因素（"对患者的预后披露"[beta = 0.082，P = 0.039]，"患者和家属的不安"[beta = 0.127，P = 0.001]，以及"家属对何时根据临终意识采取行动的不确定感"[beta = 0.141，P = 0.000]）和一个结局因素（"获得了一个好的死亡"[beta =-0.152，P =0.000]）对无意说话的后悔有贡献。三分之一的成年癌症患者家属后悔没有充分谈论死亡。临床医生可以通过促进对疾病和预后的共同理解来减少这种遗憾，明确建议家属何时根据终端意识进行交谈，提供持续的情感支持，并验证他们关于谈论死亡的决定。(C)2017年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
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'' [beta = 0.082, P = 0.039], "upsetting of patient and family'' [beta = 0.127, P = 0.001], and "family's sense of uncertainty about when to act based on terminal awareness'' [beta = 0.141, P = 0.000]) and an outcome factor ("having achieved a good death'' [beta = -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. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.