"Guidebook on Doctors' Behaviors for Death Diagnosis Created by Community Healthcare Providers" Changed Residents' Mind for Death Diagnosis.

BACKGROUND: Education regarding death diagnosis is not often included in the medical education. OBJECTIVE: To investigate the change minds at the time of death diagnosis among residents after lectures based on our guidebook. DESIGN: Uncontrolled, open-label, multi-center trial. SUBJECTS: A total of 131 doctors undergoing their initial training were enrolled this study. MEASUREMENTS: Questionnaires were administered to volunteers before and after the lecture by the clinical training instructor presented information regarding doctors' behaviors at the death diagnosis based on our guidebook at each hospital. RESULTS: The subjects had an average age of 27.1 years and comprised 76 men (58.0%) and 54 women (41.2%). A total of 83 subjects (63.4%) had learned how to diagnose death as medical students, and 52 subjects (39.7%) had experienced death diagnosis scenes as medical students. Among those who had difficulties related to death diagnoses, the highest number (88.4%) indicated that "I do not know what to say to the family after a death diagnosis". Self-evaluation significantly increased after the lecture for many items concerning explanations to and considerations of the family: the effect size for "Give words of comfort and encouragement to family" increased significantly after the lecture to 0.9. CONCLUSIONS: Few of the residents felt that they had received education regarding death diagnoses; they reported difficulties with diagnosing death and responding to patients' families. After the lecture using our guidebook, residents' mind changed significantly for death diagnosis, suggesting that the guidebook at the time of death diagnosis may be useful.

Death Pronouncements: Recommendations Based on a Survey of Bereaved Family Members.

PURPOSE: To clarify the family-perceived necessity of improvement in death pronouncement and explore the potential association between behaviors of physicians and the family-perceived necessity of improvement. SUBJECTS AND METHODS: A questionnaire survey was conducted involving 226 bereaved family members of patients who had died at home while receiving hospice service. A total of 91 responses were analyzed (response rate, 47%). RESULTS: All pronouncements were performed by physicians. A total of 89% (n = 81, 95% confidence interval, 81%-94%) of family members reported that they felt no necessity of improvement at all or that almost no improvement was needed. Behaviors of physicians significantly positively correlated with the family-perceived necessity of improvement were that physicians acted calmly, and were not rushed. Those negatively associated were that physicians did not verify the time of death clearly, left the patient's clothes disheveled, and touched the family members' backs or shoulders as an expression of empathy. More than 90% of family members recommended that physicians act calmly, have a suitable appearance for the situation, introduce themselves to family members, explain the cause of death explicitly, and conduct a check using a light and stethoscope for death pronouncement. CONCLUSION: Most of the family members who had experienced a patient's death at home were satisfied with the death pronouncement. Several factors were associated with family satisfaction, and further large studies are needed to confirm the results.

["Manual on physician behavior at the time of death certification" created through collaboration with different local healthcare workers].

It is thought that physicians' behavior at the scene of death certification has a considerable influence on the grief of the bereaved. We constructed a manual to guide the physician's behavior at death certification and educate residents and medical students. We collaborated locally across several occupations(e.g., visiting nurse, visiting pharmacist)for the purpose of upgrading the manual. We conducted interviews with physicians and nurses who perform home medical care in this area regarding the scene at a real death certification in making our manual. It was evaluated well in this trial, and participants were cooperative with the interview. We can conduct many collaborations locally in various forms. The regional alliances become smoother as a function of such collaborations. In addition, it is thought that the manual that was constructed following this process will be easily received in the area.

[A case of an elderly woman with dementia in whom nutrition via gastrostomy was discontinued after considerable discussion according to the guidelines].

A 94-year-old woman with Alzheimer's disease had been receiving nourishment via gastrostomy for three years and in a state in which communication was not possible. Upon the family's request for consultation and advice, and after a considerable discussion according to the guidelines, the decision was made to stop the gastrostomy feeding. The patient subsequently coincidentally contracted influenza one week later and died due to pneumonia. Based on our experience of making the decision to stop nutritional supplementation via gastrostomy according to the guidelines, there are various issues, such as the psychological distress of the family, which cannot be resolved based on the guidelines.

[Usefulness of a manual on physician behavior at the time of death confirmation].

The behavior of a physician when confirming the death of a patient is thought to greatly affect the bereaved family. The required aspects of a physician's behavior after a patient's death are rarely included in physician education. Therefore, the few physicians who confirm the death of a patient should be conscious of the grief of the family members. A questionnaire survey was administered to nurses of a palliative care unit, and the findings showed that the behavior of an attending physician was different from that of other physicians when confirming death. We have prepared a manual that specifies the expected behavior of physicians confirming the death of patients to ensure that physicians other than the attending physician are also conscious of subsequent grief care for the bereaved family.

[Operational management in our hospice ward-from the viewpoint of supporting a patient's recuperation at home].

Although many terminally ill cancer patients desire to receive medical treatment in palliative care units(PCUs or hospices), very few patients are actually able to receive such treatment. Our aim is to provide palliative care to as many people as possible. We have practiced palliative care in general wards and prioritized care according to the patient's prognosis on admission to our hospice. From April 2007 to March 2011, 87% patients were admitted to our hospital in accordance with their wishes. By adequate management of hospital wards, including PCUs, and unitizing the health resources of the area, terminally ill cancer patients may be able to spend more time at home prior to hospitalization.

Sclerosing hemangioma isolated to the mediastinum.

Sclerosing hemangioma is an uncommon tumor of unknown histogenesis that generally develops in the lung. We report on a 48-year-old woman with a sclerosing hemangioma that was apparently isolated to the mediastinum. To our knowledge, sclerosing hemangioma arising in the mediastinum has not been previously reported. Potential mechanisms explaining the isolation of sclerosing hemangioma in the mediastinum are discussed.