Unfinished Business in Families of Terminally Ill With Cancer Patients

Yamashita, Ryoko; Arao, Harue; Takao, Ayumi; Masutani, Eiko; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho

doi:10.1016/j.jpainsymman.2017.04.013

Cited by 28 publications

(18 citation statements)

References 21 publications

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“…Our results showed that even though information about impending death was given in most cases, subsequent discussions about the actual dying process were insufficient from the bereaved relatives’ perspective. This potentially could have impact on the subsequent psychological well‐being of the bereaved [ 37 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relatives’ Survey within Seven Countries

et al. 2021

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Background. Recognized disparities in quality of end-of-life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries. Materials and Methods. Postbereavement survey by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i-CODE) questionnaire 6-8 weeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patients' last days of life. Results. From 1,683 potential participants, 914 i-CODE questionnaires were completed (response rate 54%).Approximately 94% reported the doctors treated their family member with dignity and respect "always" or "most of the time"; similar responses were given about nursing staff (94%). Additionally, 89% participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3-17.8). Although 87% participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase. Conclusion. This is the first study assessing quality of care for patients dying from cancer from the bereaved relatives' perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. Clinical trial information: NCT03566732 The Oncologist ;9999:• •

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Section: Discussionmentioning

confidence: 99%

Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relatives’ Survey within Seven Countries

et al. 2021

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“…Lack of timely explanation about impending death could leave families unprepared for their loved one’s death, resulting in a sense of having unfinished business. Even among families of cancer patients who spent the last days of life in PCUs, over a quarter reported some unfinished business [ 66 ]. Moreover, families with unfinished business had significantly higher depression and grief scores after bereavement compared with those without it.…”

Section: Communication Of Impending Deathmentioning

confidence: 99%

Prognostication of the Last Days of Life

Mori¹,

Morita²,

Bruera³

et al. 2022

Cancer Res Treat

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Accurate prediction of impending death (i.e., last few days of life) is essential for terminally-ill cancer patients and their families. International guidelines state that clinicians should identify patients with impending death, communicate the prognosis with patients and families, help them with their end-of-life decision-making, and provide sufficient symptom palliation. Over the past decade, several national and international studies have been conducted that systematically investigated signs and symptoms of impending death as well as how to communicate such a prognosis effectively with patients and families. In this article, we summarize the current evidence on prognostication and communication regarding the last days of life of patients with cancer, and future directions of clinical research.

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“…Although literature exists to generally guide clinicians through this process, it often misses the opportunity for the nuanced healing that personalized grief and loss therapy can offer. For these interventions to be successful, therapists must engage in an individualized learning process about the role of the deceased parent, pre-and postmortem communication patterns, unresolved emotional challenges involving the deceased, and divergent aspects of the grief process for the remaining family members (Yamashita et al, 2017).…”

Section: Clinical Expertise and Interpretation Of Evidence: Death Of ...mentioning

confidence: 99%

“…220 • Benson et al (Shear, 2012). How a person grieves in response to the loss of a loved one is contingent on several factors, including the personality of the bereaved person; their coping skills, support network, psychiatric history, and relationship to the deceased; any unresolved conflict or unfinished business with the deceased; socioeconomic status; and cultural and religious beliefs (Yamashita et al, 2017).…”

mentioning

confidence: 99%

Loss and bereavement: A focus on cancer and families, death of a parent, death of a young child, and sudden or violent death in families.

Benson¹,

Rolbiecki²,

Bordere³

et al. 2022

Treating Contemporary Families: Toward a More Inclusive Clinical Practice.

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All individuals will undoubtedly experience losses of both minor and major magnitude across their life course (Harvey & Weber, 1998). When a major loss occurs, particularly the loss of a loved one through death, the bereaved are commonly thrust into a period of grieving. Bereavement is a broad term used to describe the period of time that occurs after a loss during which grief is experienced. Grief, however, is primarily the intrapsychic, emotional response an individual experiences as a reaction to loss (Stroebe et al., 2008). Typical grief reactions can include sadness, numbness, shock, dis belief or denial, anxiety, mourning (i.e., external, public expressions of grief), changes in appetite, lethargy, apathy, intrusive thoughts, difficulty concentrating, and preoccupation with the deceased (e.g., Stroebe et al., 2008). Although grief reactions often overlap with symptoms of depression, anxiety, or post traumatic stress disorder (PTSD), research suggests these are uniqueCopyright American Psychological Association. Not for further distribution. 220 • Benson et al. (Shear, 2012). How a person grieves in response to the loss of a loved one is contingent on several factors, including the personality of the bereaved person; their coping skills, support network, psychiatric history, and relationship to the deceased; any unresolved conflict or unfinished business with the deceased; socioeconomic status; and cultural and religious beliefs (Yamashita et al., 2017).Several stage models of typical grief have been proposed to suggest that grieving is a linear process involving specific and ordered emotional reactions from those who become bereaved or experience loss (Stroebe et al., 2017). However, these models have largely been contested due to a lack of empirical support. Most grief and bereavement scholars do agree that most grief dissipates over time as the loss is gradually accepted and typical daily activities resume (Jacobs, 1993). Although a number of consistent thoughts, feelings, and behaviors typify typical grief reactions (e.g., sadness, yearning, disinterest in daily activities), the patterning of these reactions, as well as the degree of intensity, varies across individuals (Shear, 2012). In many grief responses, intense, omnipresent, and painful feelings of sadness transform into what Shear (2012) described as "acceptance of the inevitability of the loss, integration of its reality into ongoing life, and reimagining a future with the possibility of joy and satisfaction" (p. 2).Complicated grief, also referred to as abnormal, chronic, traumatic, pathologic, or disordered grief, occurs in individuals who continue to experience elevated levels of grief after approximately 6 to 12 months (PDQ Supportive & Palliative Care Editorial Board, 2020). Complicated grief occurs in about 15% to 30% of bereaved individuals (Bonanno, 2004). Risk factors for complicated grief can include histories of a mood or anxiety disorder, previous trauma or accumulated loss, or an insecure attachment style (Shear, 2012). Certain types...

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Unfinished Business in Families of Terminally Ill With Cancer Patients

Abstract: Many families have unfinished business. Health care professionals should coordinate the appropriate timing for what the family wishes to do, with consideration of family dynamics, including the family's preparedness, communication pattern, and relationships.

Cited by 28 publications

References 21 publications

Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relatives’ Survey within Seven Countries

Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relatives’ Survey within Seven Countries

Prognostication of the Last Days of Life

Loss and bereavement: A focus on cancer and families, death of a parent, death of a young child, and sudden or violent death in families.

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