• Kazuhiro Nakazato, Mariko Shiozaki, Kei Hirai, Tatsuya Morita, Ryuhei Tatara, Kaori Ichihara, Shinichi Sato, Megumi Simizu, Satoru Tsuneto, Yasuo Shima, and Mitsunori Miyasita.
• Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
• Psychooncology. 2018 Jan 1; 27 (1): 155-162.

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.Copyright © 2017 John Wiley & Sons, Ltd.

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