title: Existential concerns of terminally ill cancer patients receiving specialized palliative care in Japan.
abstract: BACKGROUND
  Although alleviation of existential distress is important for terminally ill cancer patients, the concept of existential distress has not been fully understood. The aim of this study was to categorize existential concerns of Japanese terminally ill cancer patients and explore care strategies based on the categorizations.
  
  
  METHODS
  A multicenter cross-sectional study in 88 terminally ill cancer patients receiving specialized inpatient palliative care was performed. The nurses explored patient existential concerns by asking several key questions, and recorded the answers that they considered typically described the patients' concerns. All statements recorded by the nurses were analyzed using content analysis methods.
  
  
  RESULTS
  A total of 89 statements were subjected to analysis. The categories and their prevalence were: relationship-related concerns (22%; isolation, concerns about family preparation, conflicts in relationship), loss of control (16%; physical control, cognitive control, control over future), burden on others (4.5%), loss of continuity (10%; loss of role, loss of enjoyable activity, loss of being oneself), uncompleted life task (6.8%), hope/hopelessness (17%), and acceptance/preparation (25%).
  
  
  CONCLUSIONS
  Existential concerns of Japanese terminally ill cancer patients were categorized as relationship-related concerns, loss of control, burden on others, loss of continuity, uncompleted life task, hope/hopelessness, and acceptance/preparation. These themes seemed to encompass universal human suffering beyond cultural differences, and this conceptualization may contribute to the development of effective therapeutic interventions to alleviate existential distress.
authors.affiliation: Seirei Hospice, Seirei Mikatabara Hospital. 3453 Mikatabara-cho, 433-8558 Hamamatsu, Shizuoka, Japan. seireihc@jt6.so-net.ne.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Masako
authors.initials: M
authors.lastname: Kawa
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Honke
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kohara
authors.forename: Etsuko
authors.initials: E
authors.lastname: Maeyama
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Uchitomi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001601:Bereavement; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006801:Humans; D007389:Internal-External Control; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care / Q000523:psychology*; D012934:Social Isolation / Q000523:psychology; D019452:Terminally Ill / Q000523:psychology*