Clinical practice guidelines for the care of psychologically distressed bereaved families who have lost members to physical illness including cancer.

The Japanese Psycho-Oncology Society and the Japanese Association of Supportive Care in Cancer developed evidence-based clinical practice guidelines for the care of psychologically distressed bereaved families who have lost members to physical illness including cancer. The guideline development group formulated two clinical questions. A systematic literature review was conducted. The level of evidence and the strength of the recommendations were graded and recommendation statements validated using the modified Delphi method. The recommendations were as follows: non-pharmacological interventions were indicated for serious psychological distress (depression and grief); antidepressants were indicated for depression; however, psychotropic medications including antidepressants were not recommended for 'complicated' grief. These guidelines will facilitate the provision of appropriate care to distressed bereaved family members and highlight areas where further research is needed.

Development of a Japanese Version of the Quality of Life at the End of Life-Cancer Scale.

CONTEXT: The Quality of Life at the End of Life-Cancer Scale (QUAL-EC) is a self-reported instrument to assesses the quality of life of patients with cancer near the end of life. OBJECTIVE: To test the reliability and validity of the QUAL-EC-J, a Japanese translated version of the QUAL-EC. METHODS: A total of 179 Japanese patients with advanced cancer completed the QUAL-EC-J, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Rosenberg Self-Esteem Scale, Multidimensional Scale of Perceived Social Support, Functional Assessment of Cancer Therapy-General Scale, and Functional Assessment of Chronic Illness Therapy-Spiritual questionnaires. We performed confirmatory factor analysis of the four structures of the QUAL-EC and exploratory factor analysis of the QUAL-EC-J. Internal consistency was assessed using Cronbach's α coefficient and validity was examined by calculating correlations with relevant scales. RESULTS: Confirmatory factor analysis showed an inadequate fit to the original QUAL-EC structure. Exploratory factor analysis revealed a three-factor structure of the QUAL-EC-J, with Cronbach's α values of 0.68-0.88. All subscales were negatively correlated with depression and anxiety. Each subscale was correlated with related measures: "symptom control" with "physical well-being"; "acceptance of disease and life" with "social and family well-being" and "meaning/peace"; and "preparation for end of life" with "emotional well-being" and "meaning/peace." CONCLUSIONS: The QUAL-EC-J has a three-factor structure with acceptable reliability and sufficient validity. Differences in the factor structure between the QUAL-EC-J and the QUAL-EC may be due to cultural factors. Study findings suggest that utilization of the QUAL-EC-J could help to improve research and clinical care in advanced cancer in Japan.

Brief, manualised and semistructured individual psychotherapy programme for patients with advanced cancer in Japan: study protocol for Managing Cancer and Living Meaningfully (CALM) phase 2 trial.

INTRODUCTION: Managing Cancer and Living Meaningfully (CALM) is a novel, brief and manualised psychotherapeutic intervention intended to treat and prevent depression and end-of-life distress in patients with advanced cancer. This phase 2 trial aims to assess the feasibility and preliminary efficacy of CALM in Japanese patients with cancer. METHODS AND ANALYSIS: This study is a single-arm clinical trial. All patients involved in the study are ≥18 years of age, have been diagnosed with advanced or metastatic solid-tumour cancer, and their expected survival is at least 6 months. CALM comprises three to six individual therapy sessions, each lasting approximately 45-60 min, provided over 3- 6 months. The participants will be asked to complete questionnaires at baseline (t0), 3 months (t1) and 6 months (t2). The primary outcomes are rates of completion of the intervention and of the outcome measures and improvement of depressive symptoms measured using the Patient Health Questionnaire-9 between t0 and t2. The criteria for the successful rate of completion is that at least 70% participants who participate in at least three sessions will complete measures at t2. The secondary outcomes are the improvement in scores on: (1) the Quality of Life at the End of Life-Cancer Scale, (2) the Experiences in Close Relationships scale, (3) the Death and Dying Distress Scale and (4) the Clinical Evaluation Questionnaire. ETHICS AND DISSEMINATION: This study was approved by the Research Ethics Committee of The University of Tokyo, Cancer Institute Hospital of Japanese Foundation for Cancer Research and Yamaguchi University. We will conduct the study in accordance with the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects. The results of this study will be submitted for peer-reviewed publication and presentation at local, national and international scientific meetings and conferences. TRAIL REGISTRATION NUMBER: UMIN000040032; Pre-results.

Validating the family coping questionnaire for eating disorders for caregivers of Japanese patients with eating disorders: association between coping strategies and psychological characteristics.

BACKGROUND: Eating disorders (ED) can adversely affect the psychological health of patients' caregivers. The present study aimed to validate a Japanese version of the Family Coping Questionnaire for Eating Disorders (FCQ-ED-J) and investigate the association between the coping strategies and psychological states of the caregivers of ED patients. METHODS: The caregivers completed the FCQ-ED-J and the Profile of Mood States. The FCQ-ED measures the coping strategies of caregivers of ED patients to the ED symptom-related behaviors. As confirmatory factor analysis did not yield an adequate model fit, the factor structure of the FCQ-ED-J was analyzed using exploratory factor analysis. Subsequently, the reliability and validity of the FCQ-ED-J were examined using Cronbach's alpha and Pearson's correlation coefficients in relation to the Profile of Mood States. RESULTS: Data from 150 caregivers, including 91 mothers and 34 fathers, was analyzed (mean age 51.1 years, SD = 12.0). The FCQ-ED-J, with 13 items grouped across four subscales ["response to binge-eating" (factor 1), "response to frequent weighing" (factor 2), "response to too much physical exercise" (factor 3), and "response to abusing laxatives and/or diuretics" (factor 4)] had Cronbach's alpha values representing acceptable to good internal consistency (0.71-0.85). Each subscale of the FCQ-ED-J was significantly correlated with the Profile of Mood States subscales. CONCLUSIONS: The FCQ-ED-J had sufficient reliability and validity. The Japanese caregivers' responses to the patient's ED symptom-related behavior were associated with their psychological states. Thus, the FCQ-ED-J may offer insight into more effective and reasonable care by caregivers for ED patients. The Family Coping Questionnaire has been used by researchers to assess the coping strategies of the relatives of patients. The present study aimed to validate a Japanese version of the Family Coping Questionnaire for Eating Disorders (FCQ-ED-J) and investigate the association between the coping strategies and psychological states of the caregivers of ED patients. Data from 150 caregivers, including 91 mothers and 34 fathers, were analyzed. The FCQ-ED-J comprised 13 items grouped into four subscales, with acceptable to good internal consistency (Cronbach's alpha values between 0.71 and 0.85). All subscales of the FCQ-ED-J were found to be statistically significantly correlated with the profile of mood states (POMS) subscales. The Japanese caregivers' responses to the patient's ED symptom-related behavior were associated with their psychological states. Thus, the FCQ-ED-J can be utilized to help caregivers provide more effective and reasonable psychological care and support to ED patients.