Hiroyuki Otani1, Saran Yoshida2, Tatsuya Morita3, Maho Aoyama4, Yoshiyuki Kizawa5, Yasuo Shima6, Satoru Tsuneto7, Mitsunori Miyashita8. 1. Department of Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka, Japan. Electronic address: cas60020@pop21.odn.ne.jp. 2. Department of Clinical Psychology, Tohoku University Graduate School of Education, Sendai, Miyagi, Japan. 3. Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan. 4. Department of Community Health, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. 5. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. 6. Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan. 7. Palliative Care Center, Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. 8. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
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.
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 cancerpatients 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.
Authors: Jeffrey R Hanna; Elizabeth Rapa; Louise J Dalton; Rosemary Hughes; Tamsin McGlinchey; Kate M Bennett; Warren J Donnellan; Stephen R Mason; Catriona R Mayland Journal: Palliat Med Date: 2021-03-30 Impact factor: 4.762