Mori Masanori, Morita Tatsuya, Igarashi Naoko, Shima Yasuo, Miyashita Mitsunori
Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
BMJ Support Palliat Care. 2018 Jun;8(2):221-228. doi: 10.1136/bmjspcare-2017-001460. Epub 2018 Jan 23.
Explanation 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.
In 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.
Among 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).
Nearly 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.
向癌症晚期患者的家属解释患者即将面临的死亡情况对他们来说很重要。然而，关于临床医生如何解释即将到来的死亡以及家属如何看待这种解释，我们知之甚少。我们旨在阐明丧亲家属对改善即将到来的死亡解释的必要性的看法，并探讨导致这种必要性的因素。
在一项针对日本住院临终关怀机构收治的818名癌症患者丧亲家属的全国性调查中，我们评估了家属认为在即将到来的死亡解释方面需要改进的程度以及家属对这种解释的体验。
在所有参与者（n = 516，63%）中，分别有35户（6.8%）、123户（24%）和297户（58%）家属认为需要大幅/相当大、一些和不需要改进。需要改进的独立决定因素包括患者年龄较小（比值比[OR]=0.97；95%置信区间[CI]0.95至0.99；P = 0.009）；未收到“关于即将到来的死亡身体迹象的明确解释”（OR = 0.67；95% CI 0.51至0.88；P = 0.004）；未收到“关于患者和家属还能交谈多久的解释”（OR = 0.67；95% CI 0.51至0.88；P < 0.001）；收到“关于即将到来的死亡的过度警告”（OR = 1.45；95% CI 1.03至2.03；P = 0.033）以及有“因对未来变化的模糊解释而产生的不确定感”（OR = 1.77；95% CI 1.38至2.27；P < 0.001）。
近三分之一的丧亲家属认为在即将到来的死亡解释方面有一定的改进需求。为了更好地帮助患者/家属为临终做好准备，临床医生应该识别并解释各种即将到来的死亡迹象；在详细解释和过度警告之间找到平衡，并说明在剩余时间里他们还能交谈多久。
