{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:06:36Z","timestamp":1788973596716,"version":"build-2803163510"},"reference-count":40,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Palliat Care"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to identify who initiated end-of-life discussions (EOLD) and to examine how the timing and initiator of these discussions are associated with bereaved family members\u2019 understanding and fulfilling of patients\u2019 medical and care-related hopes and wishes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This retrospective cross-sectional study analyzed anonymous self-administered questionnaires completed by bereaved family members of patients with cancer in Japanese palliative care units. The survey included items on the occurrence, depth, timing, and initiator of EOLDs, as well as family-reported understanding and fulfilling of the patient's medical and care-related hopes and wishes. Two-way analysis of variance was conducted to examine the main effects and interaction between timing and initiator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 995 distributed questionnaires, 523 valid responses (52.6%) were obtained. Among 507 respondents included in the primary analysis, 26.6% reported fully understanding the patient's hopes and wishes. EOLDs were most frequently initiated during cancer treatment, with 41.3% initiated by healthcare providers. No significant interaction was observed for family-reported understanding. In contrast, a significant interaction between timing and initiator of EOLD was observed for fulfilling patients\u2019 hopes and wishes (partial \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.03). In particular, healthcare provider-initiated EOLDs were associated with higher fulfilling scores when conducted early.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The timing and initiator of EOLDs were associated with bereaved family members\u2019 reports of fulfilling of patients\u2019 hopes and wishes, although the effect sizes were modest. These findings suggest that earlier EOLDs\u2014particularly when initiated by healthcare providers\u2014may be associated with better outcomes in terms of fulfilling patients\u2019 hopes and wishes. Both the timing and initiator of EOLD should be considered to support effective EOLD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08258597261452747","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:54:36Z","timestamp":1779368076000},"page":"463-472","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing and Initiators of End-of-Life Discussions and Their Association With Family Members\u2019 Understanding and Fulfilment of Patients\u2019 Hopes and Wishes"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6912-9007","authenticated-orcid":false,"given":"Yukiko","family":"Tatsumi","sequence":"first","affiliation":[{"name":"University of Osaka"},{"name":"Health and Medical Sciences, Kyoto University of Advanced Science, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harue","family":"Arao","sequence":"additional","affiliation":[{"name":"University of Osaka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5993-0822","authenticated-orcid":false,"given":"Kento","family":"Masukawa","sequence":"additional","affiliation":[{"name":"Tohoku University Graduate School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Morita","sequence":"additional","affiliation":[{"name":"Seirei Mikatahara General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Kizawa","sequence":"additional","affiliation":[{"name":"Institute of Medicine, University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8219-9962","authenticated-orcid":false,"given":"Satoru","family":"Tsuneto","sequence":"additional","affiliation":[{"name":"Kyoto University Graduate School of Medicine, Japan Hospice Palliative Care Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Shima","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsunori","family":"Miyashita","sequence":"additional","affiliation":[{"name":"Tohoku University Graduate School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"issue":"3","key":"e_1_3_3_2_2","first-page":"217","article-title":"Advance care planning & end-of-life discussion","volume":"52","author":"Nishikawa M","year":"2015","unstructured":"Nishikawa M, Takanashi S, Kubokawa N, et al. 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