Background : Methods of treatment for patients with complex regional pain syndrome (CRPS) have not been established, and therefore psychological support is an essential dimension for improving their quality of life. The purpose of this study was to reveal how pain catastrophizing influences online information-seeking behavior when they gain medical information. Method : Semi-structured interviews of 4 patients with CRPS (age of range : 29-46, female : 3, non-binary : 1) were conducted to clarify the psychological process related to pain catastrophizing during information gathering. Results : The results of analysis by SCAT (Steps for Cording and Theorization) and data organization of pain acceptance processes and pain catastrophization during online information-seeking showed that the data were classified into 3 categories of rumination and 1 category of magnification. Remarks related to helplessness were not identified. Given that the characteristic psychological processes during online information-seeking behavior were rumination and magnification, it is important to note that an interaction between the two can lead to a vicious cycle of addiction. Conclusion : Reducing the pain catastrophic degree and having social support during online information-seeking will help patients be objective while consuming pain-related information online without pain catastrophizing. Thus, patients with CRPS might break the cycle of online information-seeking that can be both negative and addictive.

Messages to promote health behavior are essential when considering health promotion, disease prevention, and healthy life expectancy. The present study aimed to examine whether (1) positive and negative goal-framing messages affect message memory and behavioral intention differently in younger, middle-aged, and older adults, (2) framing effects are mediated by interest in health (health promotion and disease prevention) and emotion regulation (cognitive reappraisal and expressive suppression), and (3) mediation effects differ between positive and negative frames. Participants (N = 1248) aged 20 to 70 years were divided into positive and negative frame conditions. Framing demonstrated interactive effects on message memory; all age groups showed higher recognition accuracy in the positive than the negative frame. The accuracy of younger adults was higher than that of older adults in the negative frame, while older adults showed higher accuracy than younger adults in the positive frame. Additionally, recognition accuracy was higher in the positive frame, as participants had higher interest in health promotion and used cognitive reappraisal more frequently. Contrariwise, emotion regulation and interest in health promotion did not have significant effects on memory in negative frames. Moreover, regardless of the message valence, age did not influence behavioral intention directly but was mediated by interest in health and emotion regulation, while the older the participants were, the higher their interest in health, resulting in higher intention. For emotion regulation, intention increased with higher reappraisal scores and decreased with increasing suppression. Our results suggest that interest in health and emotion regulation should be considered when examining the relationship between age and goal-framing for health messages.

Background: Actions in preparation for death and talks about death between advanced cancer patients and their families are considered essential to achieve a good death. However, little is known about the prevalence of such actions compared with talks and their association with bereaved families' psychological morbidity. Objective: To clarify the prevalence of bereaved families having acted in preparation for death and talked about death with their loved one, and to explore their associations with bereaved families' depression and complicated grief (CG). Design: A nationwide survey. Setting/Subject: A total of 999 bereaved families of cancer patients admitted to 133 inpatient hospices in Japan. Measurements: The prevalence of families' actions in preparation for and talks about death, Patient Health Questionnaire (PHQ)-9, and Brief Grief Questionnaire (BGQ). Results: Among 678 bereaved families (response rate=68%), 513 (76%) acted in preparation for death, and 315 (46%) talked about death with their loved one. Those who acted and talked were significantly less likely to suffer depression (PHQ-910) than those who neither acted nor talked (odds ratio [OR], 0.405; 95% confidence interval [CI], 0.195-0.845; adjusted p=0.016). Families who acted were significantly less likely to suffer complicated grief (CG; BGQ 8), whether they talked (OR, 0.394; 95% CI, 0.185-0.84; adjusted p=0.016) or not (OR, 0.421; 95% CI, 0.191-0.925; adjusted p=0.031). Conclusions: Most families acted in preparation for death, and those who acted were less likely to suffer depression and CG. Clinicians may minimize families' later psychological morbidity by helping patients and families act in preparation for death.

ObjectiveTo clarify the verbal communication of feelings between families and patients in Japanese palliative care units from the perspective of bereaved family members by examining (1) proportions of families' and patients' verbalization of six feelings (gratitude, love, seeking forgiveness, giving forgiveness, wishes after death, and continuing bonds), (2) recognition of receiving these feelings through verbalization from the family's perspective, and (3) the specific attitudes of family members that influence their verbalizations.MethodsIn 2010, a cross-sectional survey was conducted with 968 bereaved families of cancer patients in palliative care units across Japan.ResultsFive hundred thirty-seven responses were analyzed. (1) Gratitude was verbalized most often (families: 47%; patients: 61%), and expressing forgiveness least often (families: 16%; patients: 11%). (2) Even if the words were not used, 81.2% to 88.2% of families answered that they had received the patient's feelings, and 71.8% to 85.4% of families felt the patient had received their feelings. (3) Multiple logistic regression analyses indicated that the strongest attitudes determining verbalizing were not wanting to say farewell without conveying feelings, a daily basis of expressing, and heart-to-heart communication (ishin-denshin).ConclusionsFor both families and patients, verbalizing feelings was difficult. Our results showed that families' and patients' verbalizing and receiving of feelings must be aligned to understand their communication at the end of life in Japan. Future research is needed to verify how attitude helps promote or inhibit verbalization.

Context. Talking about death is an important issue for terminally-ill cancer patients and their families. Little is known about how often and which bereaved families regret not having talked about death with their deceased loved one.Objectives. To explore the prevalence of a regret of not having talked about death with a deceased loved one among bereaved family members of adult cancer patients, and to systematically explore factors contributing to their regret.Methods. We conducted a nationwide survey of 999 bereaved families of cancer patients admitted to 133 inpatient hospices in Japan and surveyed families' regret on talking about death. Exploratory analyses identified the underlying structures of process, option, and outcome subscales of factors contributing to regret.Results. Among 678 bereaved families (response rate 68%), 224 (33%) regretted not having talked about death sufficiently, whereas 40 (5.9%) conversely regretted having talked about death. Three process factors ("prognostic disclosure to patient'' [beta = 0.082, P = 0.039], "upsetting of patient and family'' [beta = 0.127, P = 0.001], and "family's sense of uncertainty about when to act based on terminal awareness'' [beta = 0.141, P = 0.000]) and an outcome factor ("having achieved a good death'' [beta = -0.152, P = 0.000]) contributed to the regret of talking insufficiently.Conclusion. A third of bereaved families of adult cancer patients regretted not having talked about death sufficiently. Clinicians may minimize this regret by facilitating a shared understanding of the disease and prognosis, advising families explicitly when to talk based on terminal awareness, providing continuous emotional support, and validating their decision on talking about death. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

<p>Objectives: This study aimed to describe the experiences of bereaved family members of cancer patients in terms of regret in relation to ending terminal treatment for the patient. Methods: We conducted a semi-structured qualitative interview of 37 bereaved family members regarding their decision-making and their psychological adjustment from the time they made the decision to terminate treatment. Interviews were analyzed using qualitative content analysis. Results: Approximately 40% of bereaved family members reported that they had some regrets about their decision. Regret contents were classified into 8 categories and diversified from 4 categories at the time of decision-making to 7 categories after the death. The reasons for regret were classified into 43 categories. Common factors that minimized regret included situations at the time when they made the decision, such as patient- and family-specific factors and relationship with the medical staff. In comparison, the common reasons for regret centered on factors related to the approach for decision-making, such as the process, options, as well as psychological coping and relationships with medical staff. Conclusion: The results suggest that regret in the bereaved could be modified by understanding the relationship between regret characteristics and psychological coping.</p>

Objective: We evaluated avoidance behaviors of healthy partners of breast cancer patients and sought to (1) describe men's perception of their own avoidance behavior and (2) identify the background factors associated with such behavior.Methods: An Internet-based survey was conducted, and analysis was performed on the responses of 368 male spouses of female breast cancer patients.Results: Thirty to forty percent of spouses had some type of problem avoidance behavior toward their wives. There was a high correlation (r = 0.70, P < .001) between problem avoidance behavior at the time of diagnosis and subsequent problem behavior (mean follow-up period after diagnosis: 1.3 + 1.1years). The characteristics of spouses with avoidant behaviors included having wives with recurrence, having wives treated with anticancer drug therapy or total resection, and having their own experience of cancer. Covariance structure analysis revealed 2 factors related to the background of spouses with problem avoidance behavior: (1) having a sense of difficulty in coping (beta = 0.68, P < .001) and (2) having a poor marital relationship (beta = -0.27, P < .001).Conclusions: Our findings suggest that problem avoidance behavior among healthy male partners of breast cancer patients is common and correlates with difficulty coping and a poor marital relationship. It is important to address both the problem avoidance behavior itself and to support couples early, before this behavior surfaces.

本研究の目的は、地域在住の中高年期または高齢期の者を対象として、(1)年代と性による夫婦関係における効力感の違いを確認すること、(2)夫婦関係における3つの効力感同士の関連を検討すること、および、(3)夫婦関係における3つの効力感と主観的幸福感との関連を検討することとした。郵送法によって配布された質問紙は、配偶者への支援に関するセルフ・エフィカシー、配偶者による支援に関するアザー・エフィカシー、配偶者との互助支援に関するリレーショナル・エフィカシー、主観的幸福感などから構成されていた。1,646人(回収率41.1%)から返信が得られ、1,206人を対象として分析を行った結果、(1)性別によって、3つの効力感の得点が異なること、(2)セルフ・エフィカシー、アザー・エフィカシー、およびリレーショナル・エフィカシーが関連していること、(3)3つの効力感は、主観的幸福感と関連していることが明らかとなった。(著者抄録)

Purpose： The aim of this study was to create a list of psycho-social problems and solutions for patients with pancreatic cancer by applying the social problem-solving process. Methods： A semi-structured interview of approximately 1 hour was conducted on two occasions. The participants were 17 patients with pancreatic cancer. Results： Psycho-social problems were divided into two themes: "facing the future uncertainty" and "facing the effects of treatment received". A list of problems and solutions was created for each problem theme. Realistic goals for "facing the future uncertainty" were 'maintaining this living condition （n=7）', 'preparing for changes to the environment （n=5）', 'keeping a sense of control over my own life （n=5）' and 'dealing with anxiety （n=3）'. Realistic goals for "facing the effects of treatment received" were 'restoring the self of pre-illness（n=2）'. Conclusion： For seemingly unsolvable problems, patients can formulate realistic goals that they want to have clarified, and then the problems can be recaptured as solvable problems.

Breast cancer is the most common cancer in Japanese women. As patients with breast cancer have a lower level of mental health than healthy individuals, it is most important that they have the support of their partners to adapt to everyday life. However, 3 years after diagnosis the mental health of partners of breast cancer patients is lower than that of the patients. Few studies have examined the difficulties partners may have after their wife has been diagnosed as breast cancer. The aims of this study on partners of breast cancer patients were to investigate (l) the percentage of partners who needed information and advice services, and sympathetic support, (2) difficulties in marital communication regarding the illness, and (3) the relationship between the characteristics and difficulties in marital communication about the illness. The partners completed self-administered questionnaires (n=368). The results showed more than one-half of the partners needed support on information services (67.1 %), advice services (63.9 %), and sympathetic support (56.5%). At the time of diagnosis 66.6% of the partners had trouble grasping what his wife wanted and what he could do for her. These difficulties declined over time, however, 10-30% of partners had continuing problems regarding marital communication about the illness. Difficulties in marital communication about the illness were shown to be associated with recurrence of breast cancer, use of anticancer drug therapy, and a partner's previous experience with cancer. It is therefore necessary to provide partners who have these characteristics with information regarding marital communication about breast cancer.

Objective: The primary end points of this analysis were to explore 1) the practices of prognostic disclosure for patients with cancer and their family members in Japan, 2) the person who decided on the degree of prognosis communication, and 3) family evaluations of the type of prognostic disclosure.Method: Semistructured face-to-face interviews were conducted with 60 bereaved family members of patients with cancer who were admitted to palliative care units in Japan.Results: Twenty-five percent of patients and 75% of family members were informed of the predicted survival time of the patient. Thirty-eight percent of family members answered that they themselves decided on to what degree to communicate the prognosis to patients and 83% of them chose not to disclose to patients their prognosis or incurability. In the overall evaluation of prognosis communication, 30% of the participants said that they regretted or felt doubtful about the degree of prognostic disclosure to patients, whereas 37% said that they were satisfied with the degree of prognostic disclosure and 5% said that they had made a compromise. Both in the "prognostic disclosure" group and the "no disclosure" group, there were family members who said that they regretted or felt doubtful (27% and 31%, respectively) and family members who said that they were satisfied with the degree of disclosure (27% and 44%, respectively).Significance of results: In conclusion, family members assume the predominant role as the decision-making source regarding prognosis disclosure to patients, and they often even prevent prognostic disclosure to patients. From the perspective of family members, any one type of disclosure is not necessarily the most acceptable choice. Future surveys should explore the reasons why family members agree or disagree with prognostic disclosures to patients and factors correlated with family evaluations.

The current report provides the result of a Phase II clinical trial regarding the effectiveness and feasibility of problem-solving therapy for psychological distress experienced by Japanese early-stage breast cancer patients.Participants were 36 post-surgery Japanese breast cancer patients in a university hospital located in Osaka Prefecture, Japan. After screening for psychological distress using the Distress and Impact Thermometer and the Hospital Anxiety and Depression Scale, highly distressed patients were exposed to 5 weekly sessions of the problem-solving therapy program.Nineteen patients completed the intervention and follow-up. There was a significant difference between the pre-intervention and the 3-month follow-up in the total Hospital Anxiety and Depression Scale score (P 0.02), and the mean change score from the pre-intervention to the follow-up was 6.05 (SD 1.94). The intervention had a large effect size (d 0.82). There were also significant changes in worry, self-efficacy and quality of life measures.The findings of our study suggest that the problem-solving therapy program has potential to be effective for alleviating psychological distress experienced by Japanese early-stage breast cancer patients. The true effectiveness of the program should be confirmed by a future randomized control trial.

Background: The primary goals of this analysis were to explore the pros and cons of prognostic disclosure to patients and their families from the bereaved family's point of view.Methods: Semistructured interviews were conducted with 60 bereaved family members of patients with cancer in Japan.Results: There were eight categories of influence related to the disclosure of prognosis to the family, including pros (e.g., "Enabling mental preparedness for the patient's death") and cons (e.g., "Being distressed by acknowledging the patient's prognosis''); and seven categories of influence of not disclosing the prognosis to family, including pros (e.g., "Being able to maintain hope") and cons (e.g., "Being prevented from providing adequate care for the patient"). There were also nine categories of influence related to the disclosure of prognosis to patients (e.g., "Enabling various discussions regarding death with the patient"), and eight categories of influence related to not disclosing the prognosis to patients (e.g., "Maintaining the patient's hope").Conclusions: Although prognostic disclosure to family members can contribute to psychological distress and hopelessness, at the same time, it has the potential to prepare them for the future both emotionally and practically, and also to make the time until the patient's death as meaningful as possible. It is useful for physicians to introduce pros and cons of prognostic disclosure to family members at the time of decision making, to understand the family members' psychological state, and to provide support considering pros and cons whether or not they disclosed prognosis.

Background: The purpose of this study was to investigate the association between depression symptoms 1 year after onset and subsequent cardiovascular events among survivors of myocardial infarction (MI).Methods and Results: The participants were recruited from respondents to a district-based survey known as the Osaka Acute Coronary Insufficiency Study. Of 4,271 eligible MI patients, 1,951 completed the Zung Self-Rating Depression Scale (SDS) at their 1-year follow-up examination. After excluding patients who experienced cardiovascular events within 1 year, the data for the remaining 1,307 male patients and 280 female patients were analyzed. Among male patients, depression status at 1 year after onset of MI was significantly related to risk of subsequent cardiovascular events throughout the follow-up period (median 2.9 years). The male patients in the top vs. bottom tertiles of SDS scores (top tertile being >= 42) had a multivariable-adjusted hazard ratio (HR) of 1.67 (95% confidence interval (Cl) 1.01-2.77, P=0.04), and a 1-SD increment in SDS score was significantly related to a heightened risk of cardiovascular events, with a multivariable-adjusted HR of 1.30 (95% CI 1.07-1.58, P=0.01). There were no significant associations between SDS scores and cardiovascular events among female patients.Conclusions: Depression symptoms 1 year after onset of MI are a significant predictor of subsequent cardiovascular events for male patients. (Circ J 2011; 75: 2878-2884)

Background: This study explores the distribution of public awareness, knowledge of availability, and readiness for palliative care services, and the perceived reliability of information resources as part of a nationwide palliative care implementation intervention in Japan (Outreach Palliative Care Trial of Integrated Regional Model [OPTIM]).Methods: A cross-sectional anonymous questionnaire survey was conducted, and 3984 responses were used in the final analysis.Results: A total of 63.1% of respondents admitted having no knowledge about palliative care, while 0.5% of respondents were using palliative care services. Respondents who knew about palliative care services, yet did not know about their availability were 18.6% of all respondents. Respondents who had cancer-related experiences were more likely to be aware of palliative care compared to the general population and availability of palliative care services. Only awareness of palliative care was significantly associated with two typical images, while cancer-related experiences were not.Conclusion: Findings show that the public awareness of palliative care services and their availability is insufficient, and cancer-related experiences affect awareness of cancer palliative care but not directly related to typical images for palliative care such as care for patients close to death.

Context. Prognosis is difficult to discuss with patients who have advanced cancer and their families.Objectives. This study aimed to explore the experiences of families of patients with cancer in Japan in receiving prognostic disclosure, explore family perception of the way the prognosis was communicated, and investigate relevant factors of family-perceived need for improvement.Methods. A multicenter questionnaire survey was conducted with 666 bereaved family members of patients with cancer who were admitted to palliative care units in Japan.Results. In total, 86.3% of the families received prognostic disclosure. The overall evaluation revealed that 60.1% of the participants felt that the method of prognostic disclosure needed some, considerable, or much improvement. The parameter with the highest value explaining the necessity for improvement was the family perception that the amount of information provided by the physician was insufficient (beta = 0.39, P < 0.001). Furthermore, the family perception that they had lost hope and that health care providers failed to facilitate preparation for the patient's death had significant direct effects on the necessity for improvement (beta = 0.21, P < 0.001; and beta = 0.18, P < 0.001, respectively). The feelings for the necessity for improvement also were affected significantly by seven communication strategies (i.e., not saying "I can do nothing for the patient any longer,'' pacing explanation with the state of the patient's and family's preparation, saying "We will respect the patient's wishes,'' making an effort to understand the family's distress, being knowledgeable about the most advanced treatments, assuring continuing responsibility as the physician for medical care, and respecting the family's values).Conclusion. This model suggests that strategies for care providers to improve family perception about prognostic disclosure should include 1) providing as much prognostic information as families want; 2) supporting families' hopes by keeping up with up-to-date treatments and by assuring the continuing responsibility for medical care; 3) facilitating the preparation for the patient's death by providing information in consideration of the family's preparations and values; 4) stressing what they can do instead of saying that nothing can be done for the patient; and 5) assuring the family that they will respect the patient's wishes. J Pain Symptom Manage 2011; 41: 594-603. (C) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Significant others play an important role in providing support in patients' lives, but some types of support negatively affect the patients. This study was conducted in early-stage breast cancer patients to examine the structure of support, which was provided by their significant others and assessed negatively by the patients, and to identify negative support relating to the psychological adjustment of these patients. Thus, we first conducted interviews among 28 breast cancer patients to identify these support items assessed as negative; next, we conducted a questionnaire survey using the resulting items in 109 postoperative patients who had early-stage breast cancer. We performed exploratory and confirmatory factor analyses and obtained a valid second-order factor structure, including superordinate factors (excessive engagement, avoidance of problems and underestimation) and subordinate factors (overprotection, encouragement and management). Among these factors, the avoidance of problems was the only factor to be negatively associated with psychological adjustment of the patients, suggesting that these patients receive problem-avoiding support. The results of our study suggest that such problem-avoiding support from significant others can be counter-productive and potentially worsen the psychological adjustment of breast cancer patients.

The purpose of this study was to examine the differences between regret over actions taken versus regret over inaction vis-a-vis bereaved family. The focal points of the study were as follows: 1) to explore the nature of unreversed regret in the bereaved; 2) to examine the association between the number and intensity of regrets and mental health and grief; and 3) to examine the effect of action and inaction on mental health and grief. Using a mail-in questionnaire, we surveyed and analyzed the results of 89 bereaved respondents. The results showed that participants had more lifetime regrets over inaction than over action taken. The number and intensity of regrets also correlated with mental health and grief. Bereaved participants who expressed regret over inaction had poorer mental health and stronger feelings of grief than those with no regrets over inaction. We discuss the implications of unreversed regret and examine regret prevention for the bereaved.

Objective: The aims of this study were to validate an instrument for measuring bereaved family members' perceptions of caregiving consequences and to examine the association between caregiving consequences and psychological distress.Methods: Cross-sectional questionnaires were administered to family members of patients who had died in regional cancer centers. We measured the Caregiving Consequences Inventory (CCI), respondent's optimism, overall reward scale, and psychological distress and collected background data. A retest was conducted.Results: Bereaved families from two regional cancer centers were surveyed (N = 189 and 109; effective response rate, 57 and 80%). By exploratory and confirmatory factor analyses, we identified four perceived reward domains: 'mastery', 'appreciation for others', 'meaning in life', and 'reprioritization', and one perceived burden domain. Although the four reward domains were highly correlated with each other (0.47 < r < 0.69), the 4-domain model was superior. The respondents with less education, strong faith, and less optimism reported fewer perceived rewards, thus demonstrating known group validity. In addition, perceived reward had little or no correlation with psychological distress. The psychometric properties of this scale were good (alpha = 0.78-0.93, ICC = 0.60-0.73) and construct validity was supported (GFI = 0.929; AGFI = 0.819; CFI = 0.749; RMSEA = 0.097).Conclusions: The CCI is valid for measuring caregiving consequences from the bereaved family member's perspective in Japan. Furthermore, it is important to use perceived rewards and burdens as a measure of caregiving consequences for improving the quality of the caregiving and bereavement experience. Copyright (C) 2008 John Wiley & Sons, Ltd.

The objective of this study was to identify the roles of clinical psychologists in palliative care teams by conducting focus group interviews. The participants were 7 physicians and nurses of highly active palliative care teams. Results from the qualitative analysis of interview content revealed that the most important knowledges needed by psychologists in palliative care is fundamental and specialized psychological knowledges and skills. The second most important was general and psychiatric medical knowledges regarding cancer. Otherwise, psychologists were expected to understand the roles of other staff members and the medical system, and provide mental and emotional support to medical staff. Our results clarified that psychologists require a broad understanding of medical care for cancer, good communication skills for interacting with other staff members, and the ability to actively utilize their psychiatric specialty to provide psychological support to patients, families and medical workers. Palliat Care Res 2009; 4(2): 228-234

Objectives: A psychometric scale for assessing cancer-related worry among cancer patients, called the Brief Cancer-Related Worry Inventory (BCWI), was developed.Methods: A cross-sectional questionnaire survey for item development was conducted of 112 Japanese patients diagnosed with breast cancer, and test-retest validation analysis was conducted using the data from another prospective study of 20 lung cancer patients. The questionnaire contained 15 newly developed items for cancer-related worry, the Hospital Anxiety and Depression Scale, The Impact of Event Scale Revised, and the Medical Outcomes Study Short Form-8.Results: Exploratory factor analysis of the 15 items yielded a 3-factor structure including (1) future prospects, (2) physical and symptomatic problems and (3) social and interpersonal problems. A second-order confirmatory factor analysis identified a second-order factor called cancer-related worry and confirmed the factor structure with an acceptable fit (chi-square (df = 87) = 160.16, P = 0.001; GFI = 0.83; CFI = 0.92; RMSEA = 0.09). The internal consistency and test-retest reliability were confirmed with the lung cancer sample. Multidimensional scaling found that cancer-related worry is separate from anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms.Conclusion: Our study succeeded in developing and confirming the validity and reliability of a BCWI. The study also confirmed the discriminable aspects of cancer-related worry from anxiety, depression, and PTSD symptoms. Copyright (C) 2008 John Wiley & Sons, Ltd.

Problem-solving therapy (PST) is a brief, structured psychological treatment. Preliminary clinical findings regarding the effectiveness of PST for treating psychological distress experienced by Japanese cancer patients are presented. Our actual clinical experience in administering PST to four consecutive distressed cancer patients was reviewed. All of the patients were breast cancer survivors who were referred to us after undergoing surgery. Three cases received six PST sessions each and one case received three PST sessions. The depression and anxiety scores decreased after PST. Our preliminary experience suggests that PST is an effective treatment for alleviating psychological distress in Japanese cancer patients and that this treatment should be further examined in a clinical trial.

Objective: The purposes of this study were to develop a bereaved family regret scale measuring decision-related regret of family members about the admission of cancer patients to palliative care units (PCUs) and to examine the validity and reliability of this scale. Method: Bereaved families of cancer patients who had died in one regional cancer center from September 2004 to February 2006 received a cross-sectional questionnaire by mail. The questionnaire contained seven items pertaining to decision-related regret about the patient's admission to the PCU, the Care Evaluation Scale (CES), an overall care satisfaction scale, and a health-related quality-of-life (QOL) scale (SF-8). One month after receiving a completed questionnaire, we conducted a retest with the respondent. Results: Of the 216 questionnaires successfully mailed to the bereaved families, we received 137 questionnaires and were able to analyze the responses for 127 of them, as the other 10 had missing data. By exploratory factor analysis and confirmatory factor analysis, we identified two key factors: intrusive thoughts of regret and decisional regret. This scale bad sufficient convergent validity with CES, overall care satisfaction, SF-8, sufficient internal consistency, and acceptable test-retest reliability. Conclusion: We have developed and validated a new regret scale for bereaved family members, which can measure their intensity of regret and their self-evaluation about their decision to admit their loved ones to PCUs. Copyright © 2007 John Wiley & Sons, Ltd.

BACKGROUND: In order to improve the quality of palliative care, we can learn from bereaved families who were dissatisfied with the care they received. The primary aim of this study was to explore why bereaved families were dissatisfied with specialized inpatient palliative care. METHODS: This qualitative study formed part of a nationwide questionnaire survey administered to 1225 bereaved family members of cancer patients who died in certified palliative care units in Japan. The participants were 22 consecutive family members who reported a greater need for improvement in care. Data were analysed by the content analysis. RESULTS: The reasons that the bereaved families listed are classified into 27 categories and seven themes: (1) lack of perceived support for maintaining hope; (2) lack of perceived respect of individuality, especially in attitudes toward death; (3) perceived poor quality of care, especially psychological care, not being treated with dignity and inadequate explanation from physicians; (4) inadequate staffing and equipment, especially physician availability; (5) unavailability of timely administration; (6) lack of accurate information about palliative care units; and (7) family's practical and economic burden. CONCLUSIONS: This study identified the multiple sources of dissatisfaction with specialized inpatient palliative care for bereaved families. These findings could be useful in developing a more desirable system of specialised inpatient palliative care.

The purpose of this study was to investigate the effects of adopted coping strategies on relationship between dispositions of spouse and state of psychological stress in spouse with cancer patient. The dispositions of spouse were evaluated using three variables, which were age of spouse, cancer stage of the patient, and the years after surgical operation of the patient. State of psychological stress was evaluated usingindices for mental health and subjective burden. Subjects were 57 female spouses (age 64.8±6.0) of gastric cancer patients who were operated after having informed cancer (year after surgical operation : 1.9±1.1). In this study, Tn-axial Coping Scale (TAC-24), Subjective Burden Scale (SBS), General Health Question-naire (GHQ) and Face sheet were used. The answers for questionnaires were obtained through a mail survey. Result of structural equation modeling analysis, this model revealed best fitting (Chi^2=5.60,p=0.69 ; GFI=0.97 ; CFI=1.00). According to this model, it was revealed that the longer time passed after surgical operation, the more families of patients adopted coping strategies of problem-avoidance. As a result, state of psychological stress was evaluated to be getting worse. Furthermore, the older they grew, the more they adopted coping strategies of emotional control. In conclusion, it is very important to support the spouse who has taken care of cancer patient after surgical operation for a long time. Furthermore, these results suggested that the effective support for spouse of cancer patient could be achieved if one could find a way to prevent the tendency of the spouse to use coping strategies of problem-avoidance. Results of this study were discussed from the viewpoint of support system for spouse with cancer patient.

The purpose of this study is to investigate quality of life (QOL) and psychological distress in Japanese breast cancer patients. A total of 112 post-operation patients participated in this study. The correlation between QOL and other psychological distress factors was analyzed by multiple regression analysis. Depression (HADS) and both positive and problematic support (ISSS) had a significant impact on physical QOL. Anxiety (HADS) and depressive coping (DWI) had a significant impact on mental QOL. This result indicated that control of depression and anxiety might contribute to the improvement of both physical and mental QOL in Japanese breast cancer patients.

人の思考は合理的ではなく，選択や判断の際には認知バイアス(非合理的な選択の偏り)が生じる。特に高齢期では加齢に伴い合理的判 断の基盤となる認知機 能が低下するため，どれだけ客観的・合理的な情報であっても認知バイアスを考慮した情報提示でなければ，適切な判断や行動に結びつかない。しかしながら， 高齢者の自律支援において，どのような情報提示のあり方が最適なのかついて，十分な検討がなされておらず，確立された手法も存在しない。本研究の目的は， 1)認知機能の低下の影響を受けにくい情報提示方法，2)満足でき後悔しない選択のための情報提示方法，3)過剰な影響を排除し自律を阻害しない情報提示方法 の3つを検討することである。 本年度は，20歳から70歳代の421名を対象とし，商品の購買の際に、白紙の状態からほしいオプションを追加する方法（加法条件）に比べ、すべて選択されている状態から必要ないオプションを削除する方法（減法条件）のほうが、数多くオプションを選択するオプションフレーミング効果に影響する要因及び，熟考を促すことによりオプションフレーミング効果を抑制することが可能か検討した。 その結果，性格特性と選択するオプション数に関連性がみられ減法条件では，神経症傾向が高いほどオプション選択数が多かった。また，最高の選択がしたいという動悸が高い人ほど減法条件においてオプション選択の困難度評価が高かった。オプションフレーミング効果の抑制については，熟考を促してもオプション選択数に違いがみられなかった。このことは，オプションフレーミング効果が自動的・無意識的な処理に依存し頑健な効果であることを示唆している。

A series of experiments and surveys suggested that the use of emotion regulation strategies in older age is less affected by age-related decline in cognitive function in the healthy range, and that the quality of information processed (positive or negative information) affects emotion regulation and emotions more than cognitive performance. It was also suggested that the type of emotion regulation strategy used was related to social connectedness and loneliness. On the other hand, the use of others for emotion regulation decreased with age, and emotion regulation used by spouses who had lived together for a long time did not predict their own mental health, suggesting that emotion regulation strategies in old age may be completed within the individual.

A series of studies confirmed the importance of culturally and socially appropriate emotion regulation in the face of death in order to avoid regret during end-of-life decision making. Emotional regulation through acceptance, based on the Yin-Yang philosophy, was shown to be effective for minimizing/preventing regret when facing death among Japanese. In addition, we had developed the “Life Value Orientation Scale”and had shown that valuing life may lead to acceptance of life and a reduction in regret. Based on these results, we proposed the need to develop a decision-making support program. This specific program can promote effective emotion regulation strategies, after confirming the path toward the ideal emotional state, by confronting the value of one’s life through life value orientation.

The purpose of this research is to clarify the characteristics of decision-making biases in elderly people and to find methods of decision-making support that are suitable for elderly people. We conducted research on age-based changes in cognitive biases (such as framing, anchoring effects, sunk-cost fallacy, and so on) in daily decision making in the elderly, as well as satisfaction and regret about choices (e.g., surrogated decision making among the families of dementia patients.). These research showed that the decision of the elderly adults is not necessarily inferior to the young adults. For example, elderly adults make decisions that emphasize positive information. Therefore, the tendency of loss aversion is smaller than younger adults, which leads to rational judgment of elderly adults.

A series of studies were conducted on general elderly people and elderly bereaved families with patients who survived cancer, to formulate a proposal to provide psychological support for elderly cancer patients and their families so that they did not regret terminal treatment choices. Studies on the characteristics of the regrets of the bereaved families were also examined to explain individual differences in sensitivity. These findings suggested that in order to minimize regret it is important to intentionally change the reference point so that it matches the situation at the time the decision was made. Studies on general elderly people suggested that it was important to build relationships without the fear of dealing with emotions expressed in daily conversation in order to face family-related decisions made at the final stage of life.

In order to obtain basic knowledge for developing a psychological support program for cancer patients and their families when the patient chooses treatment in the end-of-life stage, we conducted an awareness survey of ordinary adults and an interview survey of families of cancer patients. The results showed when we apply the conventional decision-making model to the choice of end-of life treatment, it is necessary to pay attention to the following three points: First, the future time perspective of the patient and his or her family affect the framework of the decision; Second, their belief towards life-sustaining treatment encourages intuitive decision-making; Third, the convincing criteria for decision-making are different between the patient and his or her family. In the future, we need to examine the decision-making model for the end of life empirically and continue to improve to make it suit the current conditions.

本年度は、乳がん患者に対する縦断的質問紙調査を引き続き行ったことに加え、乳がん患者の配偶者に対する質問紙調査を行い、結果をまとめた。 まず、乳がん患者に対する縦断的調査の7時点のうち、入院時(T1;N=201)、1ヶ月後(T2;N=196)、半年後(T3;N=196)のデータを用いて、解析を行った。親しい他者からのネガティブサポートの中で、過剰関与と問題回避は時間の経過に従って減少するサポートであり、過小評価は変化しないサポートであることが示された。また、各時点でのネガティブサポートが心理的適応に及ぼす影響を検討したところ、3時点ともに問題回避のみが有意な影響を及ぼしていた(T1:β=0.27,p<0.01;T2:β=0.34,p<0.01;T3:β=0.27,p<0.01)。親しい他者が問題回避していると報告している患者には、NEOによる性格傾向に特徴はなかったが、感情抑制傾向が強いことがわかった(r=0.27,p<0.01)。このことから、二者間の問題回避は、どちらか片方ではなく両者のダイナミズムの問題として捉える必要があることが示唆された。 そのため、乳がん患者の配偶者(N=368)を対象に、どの程度患者に対して問題回避を行っているのか、また、問題回避を行う配偶者の特徴を調べることを目的に質問紙調査を行った。その結果、ときどきよりも頻回に問題回避をしている配偶者が、診断直後では約半数、また現在(術後平均2.4年)でも約35%いることが明らかになった。また、配偶者自身の問題回避と患者がとっていると認識している問題回避との相関は強かった(r=0.62,p<0.01)。問題回避をとる配偶者の特徴として、がんに対する脅威性が高い、侵入想起症状が強いという特徴が明らかとなり、問題回避をとることには、配偶者の性格傾向や家族機能ではなく、配偶者自身の心理的不適応が背景にあることが明らかとなった。 これらの結果から、患者と配偶者の両者の視点にたった心理支援ツールを開発し、乳腺外科のある病院やクリニックの外来、ホームページなどで情報発信する準備を進めている。

本研究では、乳がん患者が配偶者との日常生活において、配偶者が良かれと思って行っているであろうサポート態度が、患者にとってサポートとならない場合について着目している。先に行った乳がん患者に対する半構造化面接で得られた、患者にとって「ありがた迷惑」、「大きなお世話」といった配偶者からのネガティブサポート態度に関する15項目を用いて、手術前と手術後においてどのような変化が見られるかを縦断的に明らかにした。 手術前と術後1ヶ月に質問紙調査を行ったところ、ネガティブサポート態度に関して欠損値がなかった乳がん患者63名(平均年齢:49.3±8.9歳)を分析対象とした。半構造化面接で得られた15項目は、比較的頻度の高いもの(早く元通りになるようにとあなたを励ます・あなたの病気や治療のことは、全て医師にまかせるものとして関与しない・自分のことよりも、常にあなたのことを優先する)、比較的頻度の低いもの(あなたと病気についての話をすることを避ける・あなたを病人として、はれものに触るように大事にする)が含まれていた。また、これら15項目は探索的因子分析と検証的因子分析を経て、3下位因子によって説明された。その3つの下位因子は、「過剰関与」、「問題回避」、「過小評価」と命名されている。 術前と術後に変化が見られるかどうかを繰り返しのある分散分析で検討したところ、「過剰関与(F(1,62)=6.19,p<0.05)」と「問題回避(F(1,62)=10.35,p<0.01)」において有意な差がみられた。このことから、配偶者からのネガティブサポート態度は、術前・術後といった治療経過の中で出現頻度の認知に変化がみられるものであることが示唆された。今後、この変化が、実際に変化しているものなのか、患者のサポートニードが変化したものなのか、患者の個人的特性や状況などの変数を加えて詳細に検討していく必要がある。