Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
Psychooncology. 2022 Feb;31(2):260-270. doi: 10.1002/pon.5801. Epub 2021 Aug 28.
Family conflict during end-of-life care is an important issue for advanced cancer patients and their families, although studies are lacking. We investigated the association between family relationships and family conflict in advanced cancer patients.
This study was a secondary analysis of a nationwide multicenter questionnaire survey targeting the bereaved family members of cancer patients who died in palliative care units, general wards, or at home to evaluate the quality of end-of-life care in Japan.
A total of 1084 questionnaires (63.0%) were returned and we analyzed a total of 908 responses. In total, 38.0% of family members reported at least one family conflict during end-of-life care, and the most frequent family conflict was "about certain family members not pulling their weight" (23.5%). Multivariate linear analysis revealed family members who asserted their opinions (p < 0.001), family assessment device score (p < 0.001), worries about family finances during cancer treatment (p < 0.001), family members contacted after illness were helpful (p = 0.003), female patients (p = 0.03), and family with family relationship index ≤7 (p = 0.04) were positively associated with the outcome-family conflict (OFC) score. Proxy decision maker was selected by the patient (p = 0.003), people listened to families' worries or problems (p = 0.003), physician gave sufficient explanation (p = 0.003), living will before their illness (p = 0.038) and female bereaved family members (p = 0.046) were negatively associated with the OFC score.
It may be important for health care providers to actively assess the possibility of family conflicts according to family relationships, such as a proxy decision maker having been selected by the patient.
在癌症晚期患者及其家庭中，临终关怀期间的家庭冲突是一个重要问题，尽管相关研究较少。本研究旨在调查晚期癌症患者的家庭关系与家庭冲突之间的关系。
本研究是对一项全国多中心问卷调查的二次分析，该调查针对的是在姑息治疗病房、普通病房或家中死亡的癌症患者的丧亲家庭成员，旨在评估日本临终关怀的质量。
共回收 1084 份问卷（63.0%），分析了共 908 份回复。共有 38.0%的家庭成员报告在临终关怀期间至少发生了一次家庭冲突，最常见的家庭冲突是“某些家庭成员不尽力”（23.5%）。多变量线性分析显示，表达意见的家庭成员（p<0.001）、家庭评估工具评分（p<0.001）、癌症治疗期间对家庭财务的担忧（p<0.001）、生病后联系的家庭成员有帮助（p=0.003）、女性患者（p=0.03）和家庭关系指数≤7 的家庭（p=0.04）与结局-家庭冲突（OFC）评分呈正相关。患者选择代理决策者（p=0.003）、有人倾听家庭的担忧或问题（p=0.003）、医生充分解释（p=0.003）、生前制定了预嘱（p=0.038）和女性丧亲家庭成员（p=0.046）与 OFC 评分呈负相关。
根据患者选择的代理决策者等家庭关系，医疗保健提供者积极评估家庭冲突的可能性可能很重要。
