End-of-life communication and unresolved feelings among bereaved family members of patients with cancer: a nationwide mortality follow-back survey

Objectives To examine associations between multiple aspects of end-of-life (EOL) communication and unresolved feelings among bereaved family members of patients with cancer. Methods This secondary analysis used data from a nationwide Japanese mortality follow-back survey conducted from 2019 to 2020. Bereaved family members completed questionnaires 13–25 months after the patient’s death. The primary outcome was unresolved feelings regarding the patient’s illness and care. Explanatory variables included patient and family prognostic awareness; patient–physician, patient–family and family–physician EOL discussions and concordance between preferred and actual place of death. Cross-sectional associations were examined using survey-weighted modified Poisson regression with robust variance estimation. Results Among 52 747 participants, 35 688 (67.7%) reported unresolved feelings. Multivariable analyses included 21 624 participants with complete data. Accurate family prognostic awareness was associated with a lower prevalence of unresolved feelings (adjusted prevalence ratio (aPR), 0.87; 95% CI 0.85 to 0.89). Patient–physician, patient–family and family–physician discussions as well as concordance between preferred and actual place of death were independently associated with fewer unresolved feelings (aPRs, 0.86–0.92). Conversely, accurate patient prognostic awareness was associated with a slightly higher prevalence of unresolved feelings (aPR, 1.07; 95% CI 1.04 to 1.09). Conclusions Multiple aspects of EOL communication, including accurate family prognostic awareness; discussion involving patients, families and physicians; and concordance between preferred and actual place of death, were independently associated with fewer unresolved feelings. These findings indicate the importance of supporting family understanding of prognosis and communication involving patients, families and physicians throughout the EOL trajectory.