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悲嘆と家族・遺族のケア〓〓文　献 1） Ghesquiere AR, Patel SR, Kaplan DB, et al. Primary care providers’ bereavement care practices：Ⅱ章recommendations for research directions. Int J Geriatr Psychiatry 2014；29：1221‒9 2） Hudson P, Hall C, Boughey A, et al. Bereavement support standards and bereavement care path-way for quality palliative care. Palliat Support Care 2018；16：375‒87 3） Rietjens JAC, Sudore RL, Connolly M, et al.；European Association for Palliative Care. Definition and recommendations for advance care planning：an international consensus supported by the European Association for Palliative Care. Lancet Oncol 2017；18：e543‒e551 4） 厚生労働省．人生の最終段階における医療・ケアの決定プロセスに関するガイドライン．2018 5） Geng HM, Chuang DM, Yang F, et al. Prevalence and determinants of depression in caregivers of cancer patients：a systematic review and meta-analysis. Medicine（Baltimore）2018；97：e11863 6） Braun M, Mikulincer M, Rydall A. Hidden morbidity in cancer：spouse caregivers. J Clin Oncol 2007；25：4829‒34 7） Ferris FD, Balfour HM, Bowen K, et al. A model to guide patient and family care：based on nationally accepted principles and norms of practice. J Pain Symptom Manage 2002；24：106‒23 8） Liben S, Papadatou D, Wolfe J. Paediatric palliative care：challenges and emerging ideas. Lancet 2008；371：852‒64 9） Kurtz ME, Kurtz JC, Given CW, et al. Predictors of postbereavement depressive symptomatol-ogy among family caregivers of cancer patients. Support Care Cancer 1997；5：53‒60 10） Fulton R. Anticipatory mourning：a critique of the concept. Mortality 2003；8：342‒51 11） Nielsen MK, Neergaard MA, Jensen AB, et al. Do we need to change our understanding of antic-ipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiv-ing and bereavement. Clin Psychol Rev 2016；44：75‒93 12） Bowlby J. The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. An expanded version of the Fiftieth Maudsley Lecture, delivered before the Royal College of Psychiatrists, 19 November 1976. Br J Psychiatry 1977；130：201‒10 13） Kissane DW, McKenzie M, Bloch S, et al. Family focused grief therapy：a randomized, controlled trial in palliative care and bereavement. Am J Psychiatry 2006；163：1208‒18 14） Lewis FM, Griffith KA, Alzawad Z, et al. Helping Her Heal：Randomized clinical trial to enhance dyadic outcomes in couples. Psychooncology 2019；28：430‒38 15） Li J, Luo X, Cao Q, et al. Communication needs of cancer patients and/or caregivers：a critical literature review. J Oncol 2020；2020：7432849. 16） Hudson P, Thomas T, Quinn K, et al. Teaching family carers about home-based palliative care：final results from a group education program. J Pain Symptom Manage 2009；38：299‒308 17） Beesley VL, Price MA, Webb PM. Australian Ovarian Cancer Study Group；Australian Ovarian Cancer Study―Quality of Life Study Investigators. Loss of lifestyle：health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer. Support Care Cancer 2011；19：1949‒56に患者同様にケアの対象である。がん等の予後予測が比較的可能な疾患で患者が亡くなる場合には，遺族ケアは患者が生存している段階から始めることができる。家族のかかえている苦悩を理解しつつ，家族がその時の状況でできることを支援していくことで，少しでも心残りが軽減されるよう意識し，死別後に生じるかもしれない後悔をはじめとするさまざまな苦痛が緩和されることを目指す家族ケアが全国で提供されていくことが望まれている。（加藤雅志，竹内恵美）総論4．ケアの対象としての患者の家族　37