title: Self-perceived burden in terminally ill cancer patients: a categorization of care strategies based on bereaved family members' perspectives.
abstract: BACKGROUND
  Terminally ill cancer patients often experience a self-perceived burden that affects their quality of life; however, no standard care strategy for coping with this form of suffering has ever been established.
  
  
  OBJECTIVE
  The objectives of this present study were 1) to investigate the prevalence of self-perceived burden among terminally ill cancer patients based on a survey of family members, 2) to assess the level of family perceived usefulness of expert-recommended care strategies, and 3) to categorize the care strategies.
  
  
  METHODS
  The subjects were bereaved family members of patients who had died in certified palliative care units throughout Japan. The Good Death Inventory was used to evaluate patients' self-perceived burden based on the proxy ratings of family members. The perceived usefulness of care was assessed using a 27-item questionnaire developed by a focus group of palliative experts and a systematic review.
  
  
  RESULTS
  A total of 429 responses (64%) received from a member of each of 666 bereaved families was analyzed. In their responses, 25% of the bereaved family members reported that the patient had experienced a mild self-perceived burden, whereas 25% reported that the patient had experienced a moderate to severe self-perceived burden. The family members recommended the following as particularly effective care strategies: "Eliminate pain and other symptoms that restrict patient activity (53%);" "Quickly dispose of urine and stools so that they are out of sight (52%);" and "Support patients' efforts to care for themselves (45%)." A factor analysis showed that the expert-recommended care strategies could be categorized into seven different components.
  
  
  CONCLUSIONS
  Many terminally ill cancer patients suffer from a self-perceived burden. Family members recommended a variety of care strategies to alleviate patient-perceived burden. Palliative care specialists should have adequate knowledge of promising care strategies for alleviating patient-perceived burden.
authors.affiliation: Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Terukazu
authors.initials: T
authors.lastname: Akazawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.forename: Toshiaki A
authors.initials: TA
authors.lastname: Furukawa
mesh_terms: D000223:Adaptation, Psychological; D001601:Bereavement; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*