Takashi Yamaguchi1, Isseki Maeda2, Yutaka Hatano3, Masanori Mori4, Yasuo Shima5, Satoru Tsuneto6, Yoshiyuki Kizawa7, Tatsuya Morita8, Takuhiro Yamaguchi9, Maho Aoyama10, Mitsunori Miyashita10. 1. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Palliative Care, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan. Electronic address: ikagoro@pop06.odn.ne.jp. 2. Gratia Hospice, Gratia Research and Clinical Education (GRACE) Center, Gratia Hospital, Minoh, Japan. 3. Department of Psychosomatic Medicine, Kinki University Hospital, Osaka-Sayama, Japan. 4. Department of Laboratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 5. Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan. 6. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 7. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. 8. Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 9. Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan. 10. Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
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.
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 patientdeath 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 cancerpatients 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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Authors: Dagny Faksvåg Haugen; Karl Ove Hufthammer; Christina Gerlach; Katrin Sigurdardottir; Marit Irene Tuen Hansen; Grace Ting; Vilma Adriana Tripodoro; Gabriel Goldraij; Eduardo Garcia Yanneo; Wojciech Leppert; Katarzyna Wolszczak; Lair Zambon; Juliana Nalin Passarini; Ivete Alonso Bredda Saad; Martin Weber; John Ellershaw; Catriona Rachel Mayland Journal: Oncologist Date: 2021-06-17