Kazuhiro Nakazato1, Mariko Shiozaki2, Kei Hirai3, Tatsuya Morita4, Ryuhei Tatara5, Kaori Ichihara6, Shinichi Sato7, Megumi Simizu8, Satoru Tsuneto9, Yasuo Shima10, Mitsunori Miyasita11. 1. Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan. 2. Department of Applied Sociology, Kindai University, Osaka, Japan. 3. Department of Complementary and Alternative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 4. Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan. 5. Department of Palliative Medicine, Osaka City General Hospital, Osaka, Japan. 6. Department of Nursing, Kyoto University Hospital, Kyoto, Japan. 7. Department of Clinical Thanatology and Geriatric Behavioral Science, Osaka University Graduate School of Human Sciences, Osaka, Japan. 8. Department of Clinical Research, Innovation, and Education Center, Tohoku University Hospital, Sendai, Japan. 9. Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan. 10. Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan. 11. Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan.
Abstract
OBJECTIVE: To clarify the verbal communication of feelings between families and patients in Japanese palliative care units from the perspective of bereaved family members by examining (1) proportions of families' and patients' verbalization of six feelings (gratitude, love, seeking forgiveness, giving forgiveness, wishes after death, and continuing bonds), (2) recognition of receiving these feelings through verbalization from the family's perspective, and (3) the specific attitudes of family members that influence their verbalizations. METHODS: In 2010, a cross-sectional survey was conducted with 968 bereaved families of cancer patients in palliative care units across Japan. RESULTS: Five hundred thirty-seven responses were analyzed. (1) "Gratitude" was verbalized most often (families: 47%; patients: 61%), and "expressing forgiveness" least often (families: 16%; patients: 11%). (2) Even if the words were not used, 81.2% to 88.2% of families answered that they had received the patient's feelings, and 71.8% to 85.4% of families felt the patient had received their feelings. (3) Multiple logistic regression analyses indicated that the strongest attitudes determining verbalizing were "not wanting to say farewell without conveying feelings," "a daily basis of expressing," and "heart-to-heart communication" (ishin-denshin). CONCLUSIONS: For both families and patients, verbalizing feelings was difficult. Our results showed that families' and patients' verbalizing and receiving of feelings must be aligned to understand their communication at the end of life in Japan. Future research is needed to verify how attitude helps promote or inhibit verbalization.
OBJECTIVE: To clarify the verbal communication of feelings between families and patients in Japanese palliative care units from the perspective of bereaved family members by examining (1) proportions of families' and patients' verbalization of six feelings (gratitude, love, seeking forgiveness, giving forgiveness, wishes after death, and continuing bonds), (2) recognition of receiving these feelings through verbalization from the family's perspective, and (3) the specific attitudes of family members that influence their verbalizations. METHODS: In 2010, a cross-sectional survey was conducted with 968 bereaved families of cancerpatients in palliative care units across Japan. RESULTS: Five hundred thirty-seven responses were analyzed. (1) "Gratitude" was verbalized most often (families: 47%; patients: 61%), and "expressing forgiveness" least often (families: 16%; patients: 11%). (2) Even if the words were not used, 81.2% to 88.2% of families answered that they had received the patient's feelings, and 71.8% to 85.4% of families felt the patient had received their feelings. (3) Multiple logistic regression analyses indicated that the strongest attitudes determining verbalizing were "not wanting to say farewell without conveying feelings," "a daily basis of expressing," and "heart-to-heart communication" (ishin-denshin). CONCLUSIONS: For both families and patients, verbalizing feelings was difficult. Our results showed that families' and patients' verbalizing and receiving of feelings must be aligned to understand their communication at the end of life in Japan. Future research is needed to verify how attitude helps promote or inhibit verbalization.