• Akihiko Kusakabe, Akemi Shirado Naito, Kazue Hirano, Keiko Ikenaga, Naohiro Saitou, Hukiko Mikan, Masato Okita, Masahiko Inamori, and Tatsuya Morita.
• 1 Mirai Home Clinic , Yokohama, Japan .
• J Palliat Med. 2016 Jun 1; 19 (6): 646-51.

PurposeTo 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 MethodsA 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%).ResultsAll 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.ConclusionMost 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.

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