RESUMO
Objective: Decision-making regarding end-of-life care (EOLC) place causes psychological burden on families and 70% of bereaved families have regrets. Healthcare professionals need to support families to prevent regrets. This study aims to clarify the relationship between the factors related to the decision-making methods used to choose a place of care for terminal cancer patients and the regret experienced by bereaved families. Methods: Participants were 1110 bereaved family members of patients with cancer. The questionnaire items were as follows: the agreement between patients and their families regarding their preferred place of EOLC, decision-making methods, satisfaction with the factors involved in the decision-making processes, experience regarding communication with medical personnel, and regret experienced by the bereaved families. Results: This analysis included 332 valid responses from 343 respondents. The regret score was significantly lower for the group wherein patients and their caregivers/families had similar preferences regarding the EOLC place (P â< â0.001). Regret scores were significantly higher in the physician-led decision-making group (vs. positive role group P â= â0.004, vs. shared role group P â= â0.014). The regret scores for the bereaved family members were negatively correlated with the satisfaction scores for "friend support," "relationship with doctor," "information," "explanation by doctor," "thought as oneself," and "participation in the decision" (ρ â= â-0.207-0.400, P â≤ â0.001). Conclusions: To reduce bereaved families' regret, family members should know the patients' preferred place of EOLC, and patients and their families should be supported by physicians and nurses to understand their options and participate in the decision-making process.
RESUMO
Objective: This study aimed to identify the awareness, knowledge, and assessment of cancer cachexia among nurses who cared for patients with advanced cancer undergoing chemotherapy. In addition, we identified the factors that affected their assessments. Methods: A cross-sectional survey was conducted among nurses who cared for patients with advanced cancer undergoing chemotherapy at designated cancer care hospitals and regional cancer care cooperation hospitals between June and September 2020. We applied Bandura's triadic reciprocal causation as the research framework. The questionnaire consisted of questions on awareness, knowledge, and assessment of cancer cachexia. Single and multiple regression analyses were conducted on the relationship between each variable and the number of assessment items. Results: Questionnaires were sent to 1026 nurses, 403 of whom responded (response rate: 39.3%). Among these, 299 responses were valid, being a 74.1% valid response rate. The average age was 39.74 â± â9.65 years and the mean work experience as a nurse was 16.50 â± â9.14 years. In respect of the awareness of cancer cachexia, 93.3% of the participants answered "assessment of cancer cachexia was needed," and 75.2% answered "a nurse's role includes assessing for cancer cachexia." Only 15.4% responded positively regarding "confidence in the assessment of cancer cachexia." Regarding knowledge of cancer cachexia, the percentage of correct answers to questions about the definition of cachexia and diagnostic criteria ranged from 45.5% to 53.8%. With regard to cancer cachexia assessments, the participants assessed "weight loss or rate of weight loss (56.9%)," "symptoms affecting nutritional status (54.2%)," and "anorexia (46.2%)." Factors affecting the assessment of cancer cachexia were higher knowledge scores on cancer cachexia (P â= â0.039), routine assessment of cancer cachexia (P â< â0.001), experiences of participating in in-hospital training on cancer cachexia (P â= â0.027), and collaborating with physical/occupational therapists in the nutritional management of patients (P â= â0.025). Conclusions: Nurses held the view that their role required them to assess for cancer cachexia, but they did not feel confident in doing so. In addition, they lacked knowledge of reversible "cancer cachexia;" hence, the assessments were not routinely completed. Education on these topics and the development and standardization of tools to assess or collaborate with other professions are required.