Preparation Of Family Research Articles

Physician's Communication in Code Status Discussions for Terminally Ill Cancer Patients in Inpatient Hospice/Palliative Care Units in Japan: A Nationwide Post-Bereavement Survey

ContextCardiopulmonary resuscitation is one of the most important end-of-life care decisions. However, the experience of bereaved families during code status discussions is not well documented. ObjectiveThe aims of this study were to describe the degree of emotional distress of bereaved families when discussing code status, identify their perceived areas for improvement and determine associated factors. MethodsThis study is part of a nationwide post-bereavement survey, the Japan Hospice and Palliative care Evaluation 3 (J-HOPE3) study. Questionnaires were sent to the relatives of cancer patients who had died in palliative care units in Japan in 2014. ResultsFrom an analysis of 338 questionnaires, 37% of families reported high emotional distress during code status discussions and 32% reported a need for improvement. Multiple logistic regression analyses revealed the following were associated with high-level distress: the family had hoped for the miraculous and spontaneous recovery of the patient (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.31—4.43, P = 0.0049), the family felt they could not voice their opinion about Cardiopulmonary resuscitation (OR 2.07, CI 1.12—3.81, P = 0.02), or the physician failed to adapt the explanation to the family's preparation level (OR 0.36, CI 0.18—0.68, P = 0.0015). Factors identified for improvement were: holding discussions in a relaxing atmosphere conducive to questioning (OR 0.36, CI 0.16-0.80, P = 0.012), and ensuring the physician adapted the explanation to the family's preparation level (OR 0.47, CI 0.23-0.96, P = 0.037). ConclusionWe recommend the development of educational programs for code status discussions to improve the experience of bereaved family members.

Cultural Meaning-making in the Journey from Diagnosis to End of Life

This article is based on an ethnographic study undertaken to explore whether eight people diagnosed with terminal cancer and their families drew on aspects of their cultural identities to make sense of their journey towards death, and if so, how. Ethnographic methods were supplemented by semistructured interviews. Most participants received medical treatments until close to death and invested much effort, time, and hope in these. Consequently, they made little sense of their palliative referrals. Instead, they accommodated the biomedical cultures of treatment-oriented services, thus delaying their own and their family's preparation for death. Only three participants appeared well prepared one month prior to death. An ecological perspective helped to explain the systemic factors involved in this prioritisation. The authors make recommendations for greater involvement of social workers in palliative care, and for more attention to supporting dying people and their families to make culturally meaningful decisions in the journey toward death.

Both Maintaining Hope and Preparing for Death: Effects of Physicians' and Nurses' Behaviors From Bereaved Family Members' Perspectives

ContextBoth maintaining hope and preparing for the patient's death are important for families of terminally ill cancer patients. ObjectivesThe 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. MethodsA 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. ResultsA 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.” ConclusionAbout 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.

Preparation for the end of life in patients with advanced cancer and association with communication with professional caregivers

Previous studies regarding patients' end of life (EOL) preparation have focused mainly on practical tasks, such as advance directives. In this study, we investigate the relational and personal aspects of EOL preparation, using a patient-completed questionnaire, and examine associations with clinician-patient communication (CPC) and other variables. Patients with advanced cancer but with good performance status were recruited from 24 medical oncology clinics, to participate in a cluster-randomised controlled trial of early palliative care intervention. Measures included the Quality of Life at the End of Life preparation for EOL subscale, and measures of CPC, functional status, comorbidity, spiritual well-being and symptom severity. Using chi-squared tests, t-tests and multivariate regression analyses, we examined the variables associated with preparation for EOL. We also examined the frequency distributions of individual EOL preparation items and used logistic regression to examine their associations with adequacy of CPC. In the 469 patients, characteristics associated with better EOL preparation were better CPC, older age, living alone, less symptom burden and better spiritual well-being. Thirty-one per cent agreed that they worried 'quite a bit' or 'completely' about their family's preparation to cope with the future, and 27% agreed that they would be a burden to their family. All preparation items except regrets about life were associated with adequacy of communication. A substantial minority of patients with advanced cancer but with good performance status are concerned about EOL preparation, particularly in relation to their families. Better CPC may help patients prepare not only practically but also personally and socially in relation to the dying process and the welfare of their families.

The May Day festival

This assembly, which is designed to be read-aloud or used as a mini role-play, tells the story of one family's preparations for a May Day festival

Gender and History in Eudora Welty's "Delta Wedding"

Eudora Welty's 1946 novel Delta Wedding is famously, ostensibly a story in which nothing momentous, nothing of large historical portent, happens.' Contemporary reviewers complained of the absence of plot, and Welty herself told an interviewer in 1972 that she had made a careful investigation to find the year in which nothing very terrible had happened in the Delta by way of floods or fires or wars which would have taken the men away. Finally, she adds, settled it by the almanac.2 But Welty has also been quick to agree with readers who see the seemingly charmed world of the Fairchilds as doomed. Their Delta enclave was, she told Charles Bunting, all such a fragile, temporary thing. More pointedly, she noted, At least I hope it was. That's why I searched so hard to find the year in which that could be most evident.3 That last comment is particularly telling because it brings attention to the difficult epistemological questions of history that the novel does indeed address-in particular, what is history and what is not, how we record history's narratives, and how we can tell whether or not history is happening to us. Far from being ahistorical, Delta Wedding, I would argue, can be read not just as an ironic portrayal of a society on the verge of drastic historical change but something very like a feminist interrogation of history and historical perspective. Welty's seemingly innocuous, domestic story of a white Mississippi Delta family's preparations for a wedding is also one that problematizes the divide between public event and private sphere, male historical agents and private female backdrop, and the very making of historical narrative itself. The result, I think, is an unsettling and disorienting narrative, one that questions the way histories and stories in general are constructed as readily as it questions the charmed life of the Fairchilds. If Delta Wedding is a novel deeply engaged with history, it is at least partly because of the book's peculiar relationship with the century's two world wars. Set in 1923, the novel looks back obliquely at World War I and its impact on the Fairchilds' two most cherished members, Denis and George, and beyond that to the Civil War, which destroyed an entire generation of Fairchild men and their brothers-in-law. Not incidentally, Delta Wedding, as