What I Did for My Loved One Is More Important than Whether We Talked About Death: A Nationwide Survey of Bereaved Family Members

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.