Bathing in Terminal Care of Cancer Patients and Its Relation to Perceptions of a “Good Death”: A Nationwide Bereavement Survey in Japan

BACKGROUND: Bathing in a tub is integral to Japanese culture. It improves palliative care patients' symptoms and may improve quality of life. OBJECTIVES: This study aimed to determine the prevalence and impressions of bathing for terminally ill cancer patients and its relations to the evaluations of perceived end-of-life care and achievement of a good death. DESIGN: This was a cross-sectional, anonymous, self-report questionnaire survey. SETTING/SUBJECTS: The questionnaire for this study was sent to bereaved family members who had lost loved ones in 14 general hospitals and 187 palliative care wards in Japan. MEASUREMENTS: The bereaved family members of the patients who had actually bathed were asked about their impression of bathing. The short version of the Good Death Inventory (GDI) and the Care Evaluation Scale were used to evaluate “achievement of a good death.” In total, 1819 surveys were sent between July and September 2018 to bereaved family members of patients who had died between February 2014 and January 2018 in 14 general hospitals and 187 palliative care wards in Japan. Overall 885 questionnaires (valid response rate 48%) returned by bereaved family members were analyzed. RESULTS: Overall, 85% of bereaved family members of patients who bathed evaluated the experience positively, 86% reported that the patient's face seemed to become calm after the bath, and 28% of bereaved family members whose loved one had not bathed reported regretting it. The total GDI score for the bereaved family's desired death was 82.7 ± 13.0 for the bathing group and 75.4 ± 15.7 for the no bathing group, a significant difference (effect size = 0.52, p < 0.01). CONCLUSIONS: Bathing before death was evaluated positively and was associated with the achievement of a good death.