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Development of a home-visit nursing scale for helping spousal caregivers of terminal cancer patients develop positive perspectives of their caregiving experiences: A cross-sectional study

加利川 真理 広島大学

2020.03.23

概要

The population of Japan is aging rapidly, and this is expected to lead to an increase in the number of
cancer patients.[1] Consequently, securing locations for such patients to recuperate is an urgent issue.
In addition, 47% of Japanese citizens answered that they would like to be treated at home if they were
diagnosed with terminal cancer.[2] Based on these facts, the improvement of home palliative care
services is indispensable for terminal cancer patients. Japan’s Ministry of Health, Labour and Welfare
[3] is promoting palliative care and end-of-life medical care in the home by creating incentives for
home deaths through medical insurance and long-term care insurance. However, in Japan, the death
rate at home for cancer patients is still as low as 11%,[4] and it is assumed that the support system
for terminal cancer patients and their families at home is insufficient.
Among families caring for end-stage cancer patients, 72% had a high risk of anxiety, and over 60%
had a risk of distress and depression. [5] Additionally, in a domestic study, 79% of such families
experienced sleeplessness and 57% experienced a depressed mood. For this reason, it has been
reported that family caregivers feel helpless and guilty because they have an inability to do anything
for the patient and cannot accept the rapid deterioration of the patient’s condition. [6] It has also been
reported that the high AG score, which measures anticipatory grief, is associated with high levels of
post-loss avoidance [7] and complicated grief [8-9] in caregiving families of end-stage cancer patients.
More than 50% of families of cancer patients who have received hospice home care have clinically
significant depressive symptoms one year after bereavement.[10] In particular, the death of a spouse
has been reported to causedepressive symptoms.[11-12]
Apart from these negative psychological states, the existence of positive psychological states has been
suggested. In the West, bereaved coping strategies include “continuous bonds,” [13-14] “meaning,”
[15-16] and “emotional disclosure.”[17] However, due to differences in bereavement-related
religious/cultural factors in each country, there is no consensus on which coping strategies will
contribute to the survivor’s psychological state. In Japan, it is believed that the patient’s soul lives
forever and gives encouragement to the bereaved family.[18] Examining family caregivers, it has
become clear that 60 to 70% of caregivers have a positive perception of the caregiving experience.[1920] Lee et al.[21] report that the caregiving effort for cancer patients and the experience of spending
the last hours with the patient is important for the bereaved family caregiver. Some previous studies
have shown that bereaved families who cared for cancer patients can address their grief by adopting
a positive outlook of their experience regarding caregiving for their loved one up to their death.[2224] Thus, enhancing caregivers’ positive feelings about the care they provide is an important element
of grief support. ...

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FIGURE LEGENDS

Figure 1: Confirmatory factor analysis for the HNS-HSC, showing the Spearman’s rank correlation

coefficients between each item and factor.

Item numbers refer to those of the initial, 38-item scale, e-numbers refer to the new order of the items

in the final, 26-item scale.







Appendix 2: Existing scales for examining criterion-related validity

Scale

Japanese version of the Frommelt

Attitude Toward Care of the Dying

Scale Form B (FAT-COD-Form B-J)

Factor

Positive attitude toward caring for the dying

patient (16 items)

Perception of patient and family-centered

care (13 items)

Grief care from the beginning of home Promotion of acceptance of death and

care to the terminal period (GCBT)

explanation of the death attendance system

(6 items)

Support of continuation of the family’s care

with respect to their intent (7 items)

Sympathy for the family’s feelings (3 items)

Grief care at the patient’s deathbed Grief care at the patient’s deathbed (5 items)

(GCDB)

Grief care after the patient's death Sharing and support of the family’s

(GCAD)

experience of the patient’s death (9 items)

Psychosocial support for rebuilding life

(9 items)

Grasping of state for resuming social

activities (3 items)

 



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