title: Death Pronouncements: Recommendations Based on a Survey of Bereaved Family Members.
abstract: To clarify the family-perceived necessity of improvement in death pronouncement and explore the potential association between behaviors of physicians and the family-perceived necessity of improvement.
  
  
  
  A questionnaire survey was conducted involving 226 bereaved family members of patients who had died at home while receiving hospice service. A total of 91 responses were analyzed (response rate, 47%).
  
  
  
  All pronouncements were performed by physicians. A total of 89% (n = 81, 95% confidence interval, 81%-94%) of family members reported that they felt no necessity of improvement at all or that almost no improvement was needed. Behaviors of physicians significantly positively correlated with the family-perceived necessity of improvement were that physicians acted calmly, and were not rushed. Those negatively associated were that physicians did not verify the time of death clearly, left the patient's clothes disheveled, and touched the family members' backs or shoulders as an expression of empathy. More than 90% of family members recommended that physicians act calmly, have a suitable appearance for the situation, introduce themselves to family members, explain the cause of death explicitly, and conduct a check using a light and stethoscope for death pronouncement.
  
  
  
  Most of the family members who had experienced a patient's death at home were satisfied with the death pronouncement. Several factors were associated with family satisfaction, and further large studies are needed to confirm the results.
authors.affiliation: 1 Mirai Home Clinic , Yokohama, Japan .|2 Department of General Medicine, Yokohama City University , Yokohama, Japan .
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kusakabe
authors.affiliation: 3 Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara Hospital , Hamamatsu, Shizuoka, Japan .
authors.forename: Akemi Shirado
authors.initials: AS
authors.lastname: Naito
authors.affiliation: 4 Southern District Medical Association Visiting Nursing Station , Yokohama, Japan .|5 Nursing Department of Palliative Care Center, Cancer Institute Hospital , Yokohama, Japan .
authors.forename: Kazue
authors.initials: K
authors.lastname: Hirano
authors.affiliation: 6 Motherlike Visiting Nursing Station , Yokohama, Japan .
authors.forename: Keiko
authors.initials: K
authors.lastname: Ikenaga
authors.affiliation: 7 UW Pharmacy , Yokohama, Japan .
authors.forename: Naohiro
authors.initials: N
authors.lastname: Saitou
authors.affiliation: 8 Graduate School of Health Science, Kumamoto University , Kumamoto, Japan .
authors.forename: Hukiko
authors.initials: H
authors.lastname: Mikan
authors.affiliation: 1 Mirai Home Clinic , Yokohama, Japan .
authors.forename: Masato
authors.initials: M
authors.lastname: Okita
authors.affiliation: 9 Office of Postgraduate Medical Education, Yokohama City University Hospital , Yokohama, Japan .
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.affiliation: 3 Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara Hospital , Hamamatsu, Shizuoka, Japan .
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
mesh_terms: D001601:Bereavement; D005190:Family; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D011795:Surveys and Questionnaires; D013727:Terminal Care