title: Both maintaining hope and preparing for death: effects of physicians' and nurses' behaviors from bereaved family members' perspectives.
abstract: BACKGROUND
  Both maintaining hope and preparing for the patient's death are important for families of terminally ill cancer patients.
  
  
  OBJECTIVE
  The primary aim of this study was to clarify the level of the family's achievement of maintaining hope and preparing for death and the professional's behavior related to their evaluations.
  
  
  METHODS
  A cross-sectional, anonymous, nationwide survey was conducted involving 663 bereaved families of cancer patients who had been admitted to 100 palliative care units throughout Japan.
  
  
  RESULTS
  A total of 454 family members returned the questionnaire (effective response rate, 68%). Overall, 73% of families reported that they could both maintain hope and prepare for the patient's death. The independent determinants of the family's agreement in reference to the professional's behavior are pacing the explanation with the family's preparation; coordinating patient and family discussions about priorities while the patient was in better condition; willingness to discuss alternative medicine; maximizing efforts to maintain the patient's physical strength (e.g., meals, rehabilitation); discussing specific, achievable goals; and not saying "I can no longer do anything for the patient."
  
  
  CONCLUSIONS
  About 20% of family members reported that they could neither "maintain hope nor prepare for death." A recommended care strategy for medical professionals could include 1) discussing achievable goals and preparing for the future and pacing explanation with the family's preparation, 2) willingness to discuss alternative medicine, 3) maximizing efforts to maintain the patient's physical strength, and 4) avoid saying they could do nothing further for the patient.
authors.affiliation: Department of Internal Medicine II and Palliative Care Team, University of Miyazaki Hospital, Miyazaki, Japan. s-akemi@sb4.so-net.ne.jp
authors.forename: Akemi
authors.initials: A
authors.lastname: Shirado
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Terukazu
authors.initials: T
authors.lastname: Akazawa
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
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001293:Attitude to Death; D001601:Bereavement; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D065026:Hope; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000451:nursing / Q000523:psychology*; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D015996:Survival Rate; D013727:Terminal Care / Q000523:psychology* / Q000706:statistics & numerical data