we reminded attendants not to make careless method of"truth-telling"differed from case to remarks. As reported by Segri-Swinehart (9), it case. Generally, aged patients (70 years or more) is important for the family to be near the death- were aware of their length of life so it was not EUga bed until the very last moment necessary to follow to the fundamental rules in " Truth-te most cases. Younger patient ver, were not aware of their confrontation with death unless Acceptance of death by the patient in hospice they were informed by doctors accurately. Fur care was closely related to providing the patient thermore, they had a lot of matters to organize with accurate information regarding their condi- before death. We therefore told such patients the tion. to choose one's home as a final residence truth, providing conditions were acceptable the patient must precisely understand his/her In home hospice care, the doctors and ondition. The name of the disease, its stage, and nurse's contact time with the patient and famil he time remaining must therefore, be discussed especially with the patient, was extensive. Dur th the patient in detail ing every visit, we talked with the patient and In Japan, in most cases, the decision whether family for a least 30 minutes. Care and support or not to tell the patient the truth is made by the after"truth-telling"were provided. with such doctor or medical staff. This must be reviewed preparation, it was possible to carry out"truth with the patient's"right to know"(10) telling"and necessary explanations in most 1. the information must be given clearly comply with all of the opinions of the family 2. the patient must accept the truth within a limited time. Such situations have yet to be studied and the best way to deal with fam a relationship of mutual trust must exist be- ily conflicts is unknown octor and the family, including the patient Acceptance of Death as an Ultimate Goal 4. physical and spiritual care as well as patient pport must be provided after telling th The ultimate goal of death educ hospice care was the acceptance of death by the patient and family. Acceptance somewhat re- We concluded that these conditions could be sembled resignation but involved active discus directly applied to home hospice care. Truth- sion and thought. Deeken(3)criticized the state telling"consists of three steps for patients with of mind and psychological process of death pro- terminal cancer: naming their disease, stating posed by Kubler-Ross, and added a chapter that it is incurable, and giving the time remain- called " Stage of expecording to Deeken, a hu- tation and Hope"to her ng. Most of our patients were told the name of last(5th)stage(12).Acce the disease, that it was incurable, and the time man achieves tremendous growth of character remaining. For terminal cancer patients to de- in his or her last moment of life cide to spend their remaining days at home, the Hospice does not refer to a place, but a philoso patient had to understand her/his condition. phy. However, a patients own home was re- Discussing the time remaining was more ported to be the most suitable place, provided delicate and difficult than naming the disease. care was well arranged, for the patient to spend Selecting a suitable time to tell the patient was the remaining days with"expectation and hope difficult, but the most important factors were Patients can be masters of their own homes, and the relationship of mutual trust between the are able to live with dignity. It is the easiest place patient and doctor, and the mental condition of for them to accept death. The authors believe the the patient. We used expressions such as goal of home hospice care was to give a last touch Please organize a life plan on provisional sup- of life to the patient and family, and to allow them position that your remaining days are 30 days to live out their time together with hope. The to begin with. "The following expression was patient and family learned to live their remaining important: " I am sure that you will be fine one days with expectation and hope month from now. After that time, you will have The authors were of opinion that, at this arned extra life. You must make your life plan stage, a doctor and educator should not inter- for another one month all over again "This fere in their lives. Instead, it was important for helps the patient to be comfortable and hopeful them to play the roles exclusive to them, roles in the remaining days that could not be played by anyone other than The family, however, must be accurately in- a doctor and a nurse, so that the patient and formed regarding the time remaining. This family could learn by themselves. The doctor's Reproduced with permission of the copyright owner. Further reproduction prohibited without permissionReproduced with permission of the copyright owner. Further reproduction prohibited without permission