© 2004 European Society for Medical Oncology
Original Article |
Communication about the ending of anticancer treatment and transition to palliative care
1 Palliative Care Team and Seirei Hospice, Seirei Mikatabara Hospital, Shizuoka; 2 Psycho-Oncology Division, National Cancer Center Research Institute East; 3 Psychiatry Division, National Cancer Center Hospital East; 4 Hospice, Yodogawa Christian Hospital, Osaka; 5 Division of General Medicine and Palliative Care, Tsukuba Medical Center Hospital, Tsukuba; 6 Palliative Care Unit, National Sanyo Hospital; 7 Department of Palliative Medicine and Medical Oncology, Tokyo Metropolitan Toshima General Hospital, Tokyo; 8 Department of Palliative Medicine, Tohoku University Hospital, Miyagi; 9 Palliative Medicine, Shizuoka General Hospital, Shizuoka; 10 Palliative Care Unit, National Cancer Center Hospital East; 11 Palliative Care Unit, Kawasaki Social Insurance Hospital, Kanagawa; 12 Graduate School of Human Sciences, Waseda University, Tokyo, Japan
* Correspondence to: T. Morita, Palliative Care Team, Seirei Hospice, Seirei Mikatabara Hospital, 3453 Mikatabara-cho, Hamamatsu, Shizuoka, 433-8558, Japan. Tel: +81-53-436-1251; Fax: +81-53-438-2971; Email: seireihc{at}jt6.so-net.ne.jp
Background: Communication about the ending of anticancer treatment and transition to palliative care is a difficult task for oncologists. The primary aims of this study were to clarify family-reported degree of emotional distress and the necessity for improvement in communication methods when communicating about the ending of anticancer treatment, and to identify factors contributing to the levels of emotional distress and the necessity for improvement.
Methods: A multi-center questionnaire survey was conducted on 630 bereaved family members of cancer patents who received specialized palliative care in Japan. A total of 318 responses were analyzed (effective response rate, 62%).
Results: Thirty-nine percent of the bereaved family members reported that they were ‘very distressed’ in receiving information about the ending of anticancer treatment, and 19% reported ‘considerable’ or ‘much’ improvement was necessary in the communication methods. High-level emotional distress was significantly associated with younger patient age, female family gender, the experience of the physician stating she/he could do nothing for the patient, the physician's unwillingness to explore their feelings, and prognostic disclosure of definite survival periods without probabilities or ranges. High levels of perceived necessity for improvement in the communication methods were significantly associated with the experience of the physician stating she/he could do nothing for the patient, physicians not explaining treatment goals in specific terms, physicians not pacing the explanation with the state of family preparation, physicians not being knowledgeable about the most advanced treatments, and the atmosphere not being relaxing enough to ask questions.
Conclusions: In receiving the information about ending anticancer treatment, a considerable number of families experienced high levels of emotional distress and felt a need for improvement of the communication methods. The strategies to alleviate family distress could include: (i) assuring that physicians will do their best to achieve specific goals, without saying that they can do nothing for the patient; (ii) providing information, including estimated prognosis, in careful consideration of families' preparation and the uncertainty for each patient; (iii) exploring families' emotions and providing emotional support; (iv) acquiring knowledge about advanced treatments; and (v) making the atmosphere relaxing enough to allow families to ask questions.
Key words: communication, family, neoplasms, palliative care
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