Satomi Nakajima

INTRODUCTION: Evidence provides support for the therapeutic benefits of targeting avoidance in prolonged grief. However, it is not clear whether avoidance interferes with mourning through altered resilience to stress, as measured by heart rate variability (HRV). METHODS: Thirty-five adults (30 female; mean age: 39.2 years), who had been bereaved for more than one year, participated in this prospective, observational study. At each of the initial assessments and up to six-month follow-ups, grief symptoms were assessed using the Complicated Grief Questionnaire, and a resting electrocardiogram was recorded to extract the high-frequency component of HRV (HF-HRV). To differentiate avoidance from grief itself, principal component analysis was used. RESULTS: A nonlinear cross-sectional relationship was observed between avoidance and HF-HRV (coefficient = 0.29, p = .003); the lower the avoidance, the lower the HF-HRV in the low avoidance group. Grief improved only in the low avoidance group longitudinally. The observed relationship between increased HF-HRV and decreased grief was modified by the avoidance group, such that the low-avoidance group drove this association (estimate -0.53, 95% CI -0.86, -0.21, p = .001), while the high-avoidance group did not (estimate 0.44, 95% CI -0.32, 1.20, p = .26). CONCLUSION: Despite its palliative gain, avoidance relates to the maintenance of grief longitudinally through attenuated autonomic resilience to stress.

OBJECTIVE: This study aimed to evaluate the effects of the care coordination of pleural mesothelioma program (CCOM program), an educational program that we developed for nurses to improve their knowledge, attitude, and confidence on the care coordination of pleural mesothelioma (PM) patients. METHODS: In this randomized controlled study relative to the CCOM program, we measured the self-reported total scores of knowledge, attitude, and confidence of nurses before (pre-test) and after (post-test) the CCOM program. The CCOM program consisted of a care guide and nine study videos featuring various aspects of PM (2 h 15 min) and a face-to-face workshop (3 h 30 min). Sixty participants were randomly assigned to the intervention group (n = 30; with program) and control group (n = 30; without program). Fifty-eight participants completed the study (intervention group, 28; control group, 30). The total scores of knowledge, attitude, and confidence at pre-test and post-test were compared using one-way repeated measures analysis of variance (ANOVA). RESULTS: At pre-test, the groups showed no significant differences in age, experience of taking care of PM patients, and working department, except for the years of experience as a nurse. The CCOM program improved the knowledge, attitude, and confidence in the intervention group, whereas the control group showed stability in the scores. Repeated measures ANOVA showed significantly greater beneficial changes in the intervention group on main measurement scores. CONCLUSIONS: The CCOM program was effective in improving the knowledge, attitude, and confidence of nurses on the care coordination of PM patients.

AIM: This study aimed to examine the impact of grief and depression on reduced productivity in and outside work among bereaved family members of individuals with cancer. METHODS: We used the data from the J-HOPE-4 study, a nationwide cross-sectional survey involving the bereaved families of individuals with cancer in inpatient hospices and palliative care units across Japan. We evaluated the participants' level of grief on the Brief Grief Questionnaire, their level of depression on the Patient Health Questionnaire, and their level of productivity loss on the Work Productivity and Activity Impairment Questionnaire. RESULTS: Of the participating 902 bereaved families, 98 individuals (10.9%) corresponded to probable prolonged grief disorder (PGD) and 367 (40.7%) to possible PGD. Of the 217 individuals (24.1%) corresponded to mild depression, 89 (9.9%) to moderate depression, and 44 (4.9%) to moderate-to-severe depression. The work-related productivity losses in possible and probable PGD samples were 12.6% and 15.7%, respectively. The work-related productivity losses due to mild, moderate, and moderate-to-severe depression were 8.8%, 19.4%, and 32.5%, respectively. The productivity losses outside work in individuals with possible and probable PGD were 21.6% and 30.9%, respectively. The productivity losses in mild, moderate, and moderate-to-severe depression were 22.6%, 32.8%, and 37.0%, respectively. CONCLUSION: The impact of grief on productivity loss was comparable with that of mild to moderate depression. Both the severity of grief and depression were significantly associated with productivity losses outside work, while only depression was significantly associated with work-related productivity loss.