Original Article| Volume 60, ISSUE 6, P1163-1169, December 2020

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Rehabilitation for Cancer Patients in Inpatient Hospices/Palliative Care Units and Achievement of a Good Death: Analyses of Combined Data From Nationwide Surveys Among Bereaved Family Members



      In end-of-life care, rehabilitation for patients with cancer is considered to be an important means for improving patients' quality of death and dying.


      To determine whether the provision of rehabilitation for patients with cancer in palliative care units is associated with the achievement of a good death.


      This study involved a cross-sectional, anonymous, and self-report questionnaire survey of families of patients with cancer who died in palliative care units in Japan. We evaluated the short version of Good Death Inventory (GDI) on a seven-point scale. A logistic regression model was used to calculate the propensity score. Covariates included in this model were survey year, patients' characteristics, and families' characteristics. The associations between rehabilitation and GDI were tested using trend tests after propensity score matching adjustment.


      Of the 1965 family caregivers who received the questionnaires, available data were obtained from 1008 respondents (51.2%). Among them, 285 (28.2%) cases received rehabilitation in palliative care units. There was no difference in total GDI score between the groups with and without rehabilitation. In exploratory analyses, patients receiving rehabilitation were significantly more likely to feel maintaining hope and pleasure (mean 4.50 [SE 0.10] vs. 4.05 [0.11], respectively; effect size [ES] 0.31; P = 0.003), good relationships with medical staff (mean 5.67 [SE 0.07] vs. 5.43 [0.09], respectively; ES 0.22; P = 0.035), and being respected as an individual (mean 6.08 [SE 0.06] vs. 5.90 [0.07], respectively; ES 0.19; P = 0.049) compared with patients not receiving rehabilitation.


      Rehabilitation in palliative care units may contribute to several domains of quality of death and dying, particularly maintaining hope and pleasure. Further research is needed to investigate whether palliative rehabilitation contributes to the achievement of a good death.

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        • Fialka-Moser V.
        • Crevenna R.
        • Korpan M.
        • Quittan M.
        Cancer rehabilitation: particularly with aspects on physical impairments.
        J Rehabil Med. 2003; 35: 153-162
        • Santiago-Palma J.
        • Payne R.
        Palliative care and rehabilitation.
        Cancer. 2001; 92: 1049-1052
        • Sekine R.
        • Ogata M.
        • Uchiyama I.
        • et al.
        Changes in and associations among functional status and perceived quality of life of patients with metastatic/locally advanced cancer receiving rehabilitation for general disability.
        Am J Hosp Palliat Care. 2015; 32: 695-702
        • Javier N.S.
        • Montagnini M.L.
        Rehabilitation of the hospice and palliative care patient.
        J Palliat Med. 2011; 14: 638-648
        • Tsuji T.
        The front line of cancer rehabilitation in Japan: current status and future issues.
        J Cancer Rehab. 2019; 2: 10-17
        • Payne S.A.
        • Langley-Evans A.
        • Hillier R.
        Perceptions of a 'good' death: a comparative study of the views of hospice staff and patients.
        Palliat Med. 1996; 10: 307-312
        • Miyashita M.
        • Sanjo M.
        • Morita T.
        • Hirai K.
        • Uchitomi Y.
        Good death in cancer care: a nationwide quantitative study.
        Ann Oncol. 2007; 18: 1090-1097
        • Okamura H.
        Importance of rehabilitation in cancer treatment and palliative medicine.
        Jpn J Clin Oncol. 2011; 41: 733-738
        • Lopez-Sendin N.
        • Alburquerque-Sendin F.
        • Cleland J.A.
        • Fernandez-de-las-Penas C.
        Effects of physical therapy on pain and mood in patients with terminal cancer: a pilot randomized clinical trial.
        J Altern Complement Med. 2012; 18: 480-486
        • Oldervoll L.M.
        • Loge J.H.
        • Paltiel H.
        • et al.
        The effect of a physical exercise program in palliative care: a phase II study.
        J Pain Symptom Manage. 2006; 31: 421-430
        • Aoyama M.
        • Morita T.
        • Kizawa Y.
        • et al.
        The Japan HOspice and Palliative Care Evaluation Study 3: study design, characteristics of participants and participating institutions, and response rates.
        Am J Hosp Palliat Care. 2017; 34: 654-664
        • Masukawa K.
        • Aoyama M.
        • Morita T.
        • et al.
        The Japan hospice and palliative evaluation study 4: a cross-sectional questionnaire survey.
        BMC Palliat Care. 2018; 17: 66
        • Miyashita M.
        • Morita T.
        • Sato K.
        • et al.
        Good death inventory: a measure for evaluating good death from the bereaved family member's perspective.
        J Pain Symptom Manage. 2008; 35: 486-498
        • Miyashita M.
        • Morita T.
        • Sato K.
        • Tsuneto S.
        • Shima Y.
        A nationwide survey of quality of end-of-life cancer care in designated cancer centers, inpatient palliative care units, and home hospices in Japan: the J-HOPE study.
        J Pain Symptom Manage. 2015; 50: 38-47.e3
        • Henke C.C.
        • Cabri J.
        • Fricke L.
        • et al.
        Strength and endurance training in the treatment of lung cancer patients in stages IIIA/IIIB/IV.
        Support Care Cancer. 2014; 22: 95-101
        • Pyszora A.
        • Budzynski J.
        • Wojcik A.
        • Prokop A.
        • Krajnik M.
        Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial.
        Support Care Cancer. 2017; 25: 2899-2908
        • Jones L.
        • Fitzgerald G.
        • Leurent B.
        • et al.
        Rehabilitation in advanced, progressive, recurrent cancer: a randomized controlled trial.
        J Pain Symptom Manage. 2013; 46: 315-325.e3
        • Jensen W.
        • Bialy L.
        • Ketels G.
        • et al.
        Physical exercise and therapy in terminally ill cancer patients: a retrospective feasibility analysis.
        Support Care Cancer. 2014; 22: 1261-1268
        • Bergqvist J.
        • Strang P.
        Breast cancer patients' preferences for truth versus hope are dynamic and change during late lines of palliative chemotherapy.
        J Pain Symptom Manage. 2019; 57: 746-752
        • Loggers E.T.
        • Starks H.
        • Shannon-Dudley M.
        • et al.
        Implementing a Death with Dignity program at a comprehensive cancer center.
        N Engl J Med. 2013; 368: 1417-1424
        • Herth K.A.
        • Cutcliffe J.R.
        The concept of hope in nursing 3: hope and palliative care nursing.
        Br J Nurs. 2002; 11: 977-983