Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pairs of elderly patients and members of their family. The patients had finished anticancer treatment and made some decision about the preferred place of death. A modified grounded-theory approach was used for the data analysis. Results: Making a "tentative" decision for the place of death of the elderly patients is a process with the core category [carefully choosing the final place for self-fulfillment]. The patients were "conducting a comprehensive review of the place of death" and "embracing the wishes for a way of life without difficulty". Involving the family in making a "tentative" decision about the place of death of the elderly patients is the process with the core category [realizing the wish of patients in the terminal condition for the way for death]. The families were "examining the place of death from different aspects" and "respecting the patient's intention as far as possible". Conclusions: When the patients [carefully choosing the final place for self-fulfillment], it was important to reconcile their wishes with the burden on the families. When the families were trying to [realize the wish of patients in the terminal condition for the way for dying], it was important to balance the respect for the patient intentions and homecare they can provide for the patient. For the patients and their families, it is essential to mutually understand the intentions and wishes of the other party in decision making about the place of death.

Objective:The objective of the study was to conduct a concept analysis of “decision-making about the place of death for cancer patients” to develop a theoretical definition of the concept and identify its attributes, antecedents, and outcomes.Methods:The Rodgers' evolutionary model of concept analysis was used. A literature search for papers published from 2000 to 2017 was conducted using the keywords: “cancer,” “place,” “death,” and “decision-making” for the search of the electronic databases.Results:Thirty articles were selected for this analysis. As a result, five attributes, six antecedents, and five consequences were extracted. [options to choose as a place of death], [wishes of the patients themselves], [consideration of the burden on the family], [open discussions with other persons concerned], and [best choice according to circumstances] are considered to be the characteristics in the decision-making about the place of death for cancer patients.Conclusions:This concept is defined as “The best choice according to circumstances of the cancer patients among different options for a place of death, resulting from a careful evaluation of the wishes of these patients and the burden on the family, as well as through open discussions with other persons concerned.” Nurses need to assist patients discuss deaths with important others, such as family members, in making decisions about the place of death. Further studies are necessary to elucidate the details of the categories and relationships shown in the attributes in this study, investigating the actual conditions of the patients and their families.

Background: Mastery is a human response of gaining competence in dealing with stress and can be applied to understanding the psychological state of patients with advanced or recurrent colorectal cancer (CRC). Objective: To identify mastery in patients with advanced or recurrent CRC undergoing chemotherapy and examine associations between mastery and the patients’ sociodemographic characteristics, social support, and support from clinical staff. Methods: A self-administered survey was conducted among patients with advanced or recurrent CRC receiving outpatient chemotherapy. Participants completed the Mastery of Stress Instrument, the Multidimensional Scale of Perceived Social Support, support from clinical staff, and sociodemographic characteristics. Results: Of 76 participants, 77.6% had a stress score of ≥58 points, indicating a stress status. They achieved, in descending order, acceptance, certainty, change, and growth among mastery processes. Social support was significantly associated with mastery and all its components, and support from clinical staff was significantly associated with mastery and certainty. Conclusions: Most participants reported a high level of stress, indicating that they need support to deal with stress from a mastery perspective. Implications for Practice: Nurses should assess the stress levels of patients with advanced or recurrent CRC and provide care based on mastery to help patients come to terms with cancer-related stress. Providing emotional and social support is necessary to promote positive change and growth. Foundational: This study framed the need for nursing care for stressed patients in terms of their mastery of advanced or recurrent CRC-specific stress. Social support and clinical staff support are essential for achieving such mastery.