title: Psychological process from hospitalization to death among uninformed terminal liver cancer patients in Japan.
abstract: BACKGROUND
  Although the attitude among doctors toward disclosing a cancer diagnosis is becoming more positive, informing patients of their disease has not yet become a common practice in Japan. We examined the psychological process, from hospitalization until death, among uninformed terminal cancer patients in Japan, and developed a psychological model.
  
  
  METHODS
  Terminal cancer patients hospitalized during the recruiting period voluntarily participated in in-depth interviews. The data were analyzed by grounded theory.
  
  
  RESULTS
  Of the 87 uninformed participants at the time of hospitalization, 67% (N = 59) died without being informed of their diagnosis. All were male, 51-66 years of age, and all experienced five psychological stages: anxiety and puzzlement, suspicion and denial, certainty, preparation, and acceptance. At the end of each stage, obvious and severe feelings were observed, which were called "gates." During the final acceptance stage, patients spent a peaceful time with family, even talking about their dreams with family members.
  
  
  CONCLUSIONS
  Unlike in other studies, the uninformed patients in this study accepted death peacefully, with no exceptional cases. Despite several limitations, this study showed that almost 70% of the uninformed terminal cancer patients at hospitalization died without being informed, suggesting an urgent need for culturally specific and effective terminal care services for cancer patients in Japan.
authors.affiliation: Kyoto University School of Public Health, Kyoto, Japan. maeda@path1.med.kyoto-u.ac.jp
authors.forename: Yuko
authors.initials: Y
authors.lastname: Maeda
authors.forename: Akihito
authors.initials: A
authors.lastname: Hagihara
authors.forename: Eiko
authors.initials: E
authors.lastname: Kobori
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama