A qualitative study was conducted in an attempt to improve our understanding of the spiritual distress of terminally ill cancer patients in Japan. The subjects were inpatients at four approved palliative care units in Japan. The patients were interviewed and they expressed their own experiences in which spirituality was considered to be identifiable. Literal records of the interviews were analyzed using constant comparative analyses as proposed in relation to the grounded theory approach. The analysis included 11 inpatients and a variety of expressions of distress were obtained. After the conditions of the subjects were evaluated in order to search for common factors related to distress, consciousness of the gap between the patient's aspirations and the present situation were found to cause gap-induced distress. Distress was classified into three categories: distress due to the gap between the present situation and how the individual wanted to live, how the individual wished to die, and the individual's wish to maintain relations with others. The aspirations causing the gap were then interpreted from the viewpoint of spirituality as "anchors in life" for Japanese patients with terminal cancer. It was also revealed that in patients who possessed pictures of how they wished to die as their "anchors in life" and who were in a severe physical condition, distress increased and they became confused after their physical symptoms were relieved following admission to PCU.

Some of the patients were sincere and skillful in asking for help to live normal lives, but others found that difficult. The present findings are significant in helping nurses provide interventions to enable patients to make use of assistance or support.

The purpose of this study was to investigate how patients with cancer and their families are informed of the results of the patients' diagnoses. The bereaved families' assessments and satisfaction with the consequences of their decisions were examined after the patients' deaths. Data were collected from the bereaved families of 53 patients who had died of lung cancer at a Japanese university hospital between January 1994 and December 1997. Data were analyzed by employing descriptive statistics for each factor. Fifty-three bereaved families responded to the questionnaire. The true diagnosis-lung cancer-was disclosed to 15.1% of the patients, whereas 26.4% were told that they were suffering from lung tumors. Other less ominous clinical descriptions were given to 58.5% of the participants. Concerning the bereaved families' responses to the manner in which the decisions had been made on truth disclosure, the average degree of satisfaction was expressed as 3.7 cm on a 5.0-cm scale. An ambiguous expression such as "lung tumor" has been arbitrarily interpreted. However, simple truth disclosure to the patient does not necessarily satisfy a bereaved family. If family members can allay a patient's doubt about the diagnosis, the family's satisfaction may improve.