Purpose: The aim of this study was to clarify the experience of the bereaved families at the time of death of a patient. Methods: A cross-sectional nationwide survey of the bereaved families of cancer patients was performed at 95 palliative care units in Japan in 2007. Results: Of the 670 questionnaires sent to bereaved families, 492 were returned (73%). There were no significant differences between the level of the families' emotional distress and which doctor pronounced the death and whether the doctor was present at the moment of patients' death. Regarding the perceived need for improvement in the care of a dying patient, there were significant differences with respect to which doctor pronounced a patient's death and whether the doctor was present at the moment of a patient's death. There ware no significant differences between the attendance by doctor at the moment of patient's death and no attendance with frequent visit on that day. Conclusion: The bereaved families desire the patient's primary doctor to be present at the time of death and to then pronounce the death. However, the bereaved families consider an appropriate manner as the frequent visit by doctor on patient's last day even if the doctor do not attend at the moment of patient's death. Palliat Care Res 2010; 5(2): 162-170

Purpose： The aim of this study was to create a list of psycho-social problems and solutions for patients with pancreatic cancer by applying the social problem-solving process. Methods： A semi-structured interview of approximately 1 hour was conducted on two occasions. The participants were 17 patients with pancreatic cancer. Results： Psycho-social problems were divided into two themes: “facing the future uncertainty” and “facing the effects of treatment received”. A list of problems and solutions was created for each problem theme. Realistic goals for “facing the future uncertainty” were ‘maintaining this living condition （n=7）’, ‘preparing for changes to the environment （n=5）’, ‘keeping a sense of control over my own life （n=5）’ and ‘dealing with anxiety （n=3）’. Realistic goals for “facing the effects of treatment received” were ‘restoring the self of pre-illness（n=2）’. Conclusion： For seemingly unsolvable problems, patients can formulate realistic goals that they want to have clarified, and then the problems can be recaptured as solvable problems.

Objectives: This study aimed to describe the experiences of bereaved family members of cancer patients in terms of regret in relation to ending terminal treatment for the patient. Methods: We conducted a semi-structured qualitative interview of 37 bereaved family members regarding their decision-making and their psychological adjustment from the time they made the decision to terminate treatment. Interviews were analyzed using qualitative content analysis. Results: Approximately 40% of bereaved family members reported that they had some regrets about their decision. Regret contents were classified into 8 categories and diversified from 4 categories at the time of decision-making to 7 categories after the death. The reasons for regret were classified into 43 categories. Common factors that minimized regret included situations at the time when they made the decision, such as patient- and family-specific factors and relationship with the medical staff. In comparison, the common reasons for regret centered on factors related to the approach for decision-making, such as the process, options, as well as psychological coping and relationships with medical staff. Conclusion: The results suggest that regret in the bereaved could be modified by understanding the relationship between regret characteristics and psychological coping.

The objective of this study was to identify the roles of clinical psychologists in palliative care teams by conducting focus group interviews. The participants were 7 physicians and nurses of highly active palliative care teams. Results from the qualitative analysis of interview content revealed that the most important knowledges needed by psychologists in palliative care is fundamental and specialized psychological knowledges and skills. The second most important was general and psychiatric medical knowledges regarding cancer. Otherwise, psychologists were expected to understand the roles of other staff members and the medical system, and provide mental and emotional support to medical staff. Our results clarified that psychologists require a broad understanding of medical care for cancer, good communication skills for interacting with other staff members, and the ability to actively utilize their psychiatric specialty to provide psychological support to patients, families and medical workers. Palliat Care Res 2009; 4(2): 228-234

Objective: The purpose of this study is to clarify the characteristics of cases where decision-making is difficult and how the medical staff can deal with them in the medical field. Method: Seven oncology physicians were interviewed. The survey items include cases where decision-making is difficult, how to deal with them, and decision support. Category analysis was performed based on verbatim records. Results: First, the cases where decision-making is difficult were divided into two categories: patient factors and environmental factors. The former is further divided into two subcategories: “personal factors” include personality and, intellectual ability and “factors due to diseases and aging” that included flailing of body parts and dementia. Further, there were three categories of medical staff’s strategies: assessment, response skills, and environmental approach. Discussion: In providing information to patients, it is necessary to respond according to the patient’s intellectual state environmental factors to promote understanding. Specifically, it is effective to use patient-specific explanations, target planning, and nudges.

Purpose: In today’s medical field, it is an essential quality competency for staff to not only recognize the importance of patient decision-making and the skills to support it, but also implement it. This study aimed to establish a training program on decision support for healthcare professionals and examine its effectiveness. Method: We conducted the training at a medical institution and conducted a questionnaire survey at two points before and after the training. A total of 88 nurses and doctors participated in the survey. Result: We developed a two-hour training on the knowledge and skills needed for decision support. Questionnaire results showed improvements in literacy and efficacy before and after the training. Discussion: It was confirmed that the training led to an in-depth understanding of the participants’ decision support, and increased the sense of efficacy in their daily work, particularly through responding to patients according to patients’ cognitive and physical assessments, and in actively supporting those who have difficulty in making decisions. There were references to the significance of re-learning and the possibility of applying the training to difficult situations in participants comments. In the future, it is necessary to study decision support with reference toco-operation in the medical field where collaboration among multiple professions is indispensable.

Objective: Most cases of severe metabolic alkalosis have many causes that may result in renal failure and death. Therefore, these should be treated promptly for successful recovery.Patient: A 61-year-old man was hospitalized due to an acute kidney injury (creatinine level of 4.36 mg/dL) after a 3-month history of anorexia and recurrent vomiting. He had been treated for tuberculosis in the past.Results: Blood gas analysis revealed severe metabolic alkalosis with pH=7.66, HCO3=94 mmol/L, and pCO2=82.0 mmHg. Routine biochemical examination revealed severe hypokalemia (K 2.9 mEq/L) that was associated with prolonged QTc interval (0.52 seconds) on the electrocardiogram. Gastrofiberscopic examination also revealed severe stenosis and ulcerated scarring of the gastric pylorus and severe esophagitis. Intravenous hydration and correction of hypokalemia improved renal function and resolved metabolic alkalosis. An investigation that was repeated after 6 days revealed a creatinine level of 1.58 mg/dL, pH=7.47, HCO3=23.4 mmol/L, K=3.6 mEq/L, and QTc of 0.45 seconds. The patient underwent gastrectomy and adenocarcinoma was observed.Conclusion: We described a resolved case of severe metabolic alkalosis and acute kidney injury in a rural medical setting following conservative management.