Poster Presentation COSA-IPOS Joint Scientific Meeting 2012

Good death among elderly cancer patients in Japan based on perspectives of the general population (#401)

Tatsuo Akechi 1 , Mitsunori Miyashita 2 , Tatsuya Morita 3 , Toru Okuyama 1 , Masaki Sakamoto 1 , Ryuichi Sagawa 1 , Yosuke Uchitomi 4
  1. Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
  2. Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
  3. Department of Palliative and Supportive Care Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
  4. Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Okayama, Japan

Background: Very few findings regarding the concept of good death among elderly cancer patients have been reported. This study investigated concepts relevant to a good death among elderly subjects.

Design: A cross-sectional survey

Setting: National general population in Japan

Participants: A national sample of 2595 adults including 466 subjects who were 70 – 79 years of age.

Measurements: An anonymous questionnaire containing 18 domains (physical and psychological comfort, dying in a favorite place, good relationship with medical staff, maintaining hope and pleasure, not being a burden to others, good relationship with family, physical and cognitive control, environmental comfort, being respected as an individual, life completion, natural death, preparation for death, role accomplishment and contribution to others, unawareness of death, fighting against cancer, pride and beauty, control over the future , and religious and spiritual comfort) and two additional concepts ('pokkuri [sudden death]', and 'omakase [leaving the decisions to a medical expert]') was completed. The relative importance of the concept among two age groups (40 – 69 years vs. 70 – 79 years) was investigated using an effect size (ES).

Results: Clinically significant differences in the concept of good death were observed only for two domains and one component: “not being a burden to others (ES=-0.24)”, “role accomplishment and contribution to others (ES=0.29)”, and “omakase (leaving the decisions to a medical expert)” (ES=0.60).

Conclusion: Only a few differences in the concept of good death existed between the elderly and younger subjects. When caring for terminally ill Japanese elderly patients, medical staff should acknowledge that some elderly patients value the traditional paternalistic attitude of physicians and that not all patients want to be actively involved in decision-making.