title: Care strategy for death rattle in terminally ill cancer patients and their family members: recommendations from a cross-sectional nationwide survey of bereaved family members' perceptions.
abstract: BACKGROUND
  Bereaved family members witnessing a patient's death rattle often experience distress. However, the benefits of specific care measures aimed at decreasing death rattle-associated family distress have not yet been evaluated.
  
  
  OBJECTIVE
  To clarify death rattle-related emotional distress levels among family members and their perceptions of the need for death rattle care improvement and explore the factors influencing both these issues.
  
  
  METHODS
  A cross-sectional questionnaire survey of bereaved family members of cancer patients was conducted in 95 palliative care units in June 2007.
  
  
  RESULTS
  Six hundred sixty-three questionnaires were mailed out, and 390 (61%) responses were analyzed. Among these, 181 (46%) respondents experienced death rattle. Of these, 66% reported high distress levels and 53% perceived a strong need for improved death rattle care. Factors influencing high distress levels were the gender (female) of family members, unawareness about death rattle being a natural phenomenon, and their fear and distressing interpretations of death rattle. Factors influencing perceptions of a strong need for improved care were the gender (male) of family members, severity of death rattle, death rattle-associated discomfort to patients, family members' experiences of inadequate nursing care (e.g., repositioning) and insufficient consultation about suctioning, and their perception of uncomfortable smells.
  
  
  CONCLUSIONS
  To decrease family-perceived distress, medical staff should alleviate patient symptoms and suffering with a comprehensive care strategy, try to decrease uncomfortable smells, and communicate with family members to address distressing interpretations and fears.
authors.affiliation: Department of Nursing, National Cancer Center Hospital, Tokyo, Japan. Electronic address: yoshimiz-tky@umin.ac.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.affiliation: Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Palliative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
authors.affiliation: Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
mesh_terms: D001601:Bereavement; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D009812:Odorants; D010166:Palliative Care / Q000379:methods*; D012135:Respiratory Sounds; D012737:Sex Factors; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology; D019452:Terminally Ill
keywords: Death rattle; neoplasm; respiratory sounds; terminal care