The basic principles of the Revised Cancer Control Act of 2016 emphasize that “cancer patients can ‘comprehensively’ receive necessary support depending on their individual situation” and“ cancer patients should be able to‘ live with peace of mind’ as well as ‘maintain dignity’.” In this report, first, we overview the two frameworks, the Basic Plan to Promote Cancer Control Programs and the Designated Cancer Care Hospital Arrangement Guideline, both of which were established to achieve the principles of the Cancer Control Act. Second, we describe the current status, unsolved issues, and future perspectives of the environments for patient-centered communication in cancer clinical practice.

While some issues still remain, three current conditions from the healthcare providers' perspectives have been improved:（1）networking of healthcare providers,（2）information utilized by patients and healthcare providers, and（3）places to support patients/families. On the other hand, it is considered that the healthcare and support for cancer patients were fragmented with lack of continuity, from the patient's point of view. This would evoke a feeling that “comprehensive receipt” of the care and support is unachieved and it is a major challenge to be overcome.

In order to overcome this situation, it is mandatory to create an environment for doctors/other medical professionals/supporters to communicate intentionally and consciously with patients and their families. Along with review of ongoing efforts to achieve continued healthcare and supports for patients, it is important to strengthen communication and relationships between physicians and patients. Furthermore, it is necessary to improve organizational and community health literacy that people can easily access to information and support, understand and use them, and to create resources and environment to support patients and families in the community.

“Realization of patient-oriented cancer treatment” is one of the three main goals of the Third Basic Plan to Promote Cancer Control Programs. This goal prioritizes not only “respecting the patient's intentions,” which is part of the basic ideas of the Cancer Control Act, but also “patient-centered treatment.” Patient-centered treatment is expected to result in “patient-engagement” or “patient participation” in the future. To realize such patient-oriented cancer treatment, it is necessary to create an environment where doctors and patients can fully communicate in order to, for example, find a common ground for problems and priorities or implement treatment methods.

At present, patients are often confused by medical communication. The misunderstanding can be about the system implemented as the standard treatment; fast-changing information about new testing and/or treatment methods, such as cancer genome medicine; or changes in the meaning of medical terms due to advancements in medical care, such as anticancer drugs.

Given the above facts, the following steps could be proposed to improve medical communication environment, which is essential for the realization of patient-oriented cancer treatment: First, know the preferences of patients and families in terms of the medical treatment. Second, help patients/families choose the right treatment by providing information, improving information literacy for patients/families, and improving the environment for correctly transmitting information to patient/families. Third, propose a system that allows patients/families to receive appropriate medical care.

When we aim to construct palliative care and community development for a dignified and secure society, it is important to work from the viewpoint of communication. Communication in palliative care is usually divided into three categories as follows: between patients and families, between medical professionals, between patients/families and medical professionals. This time, we will discuss with the focus on the second of them, that is, communication between medical professionals. Cooperation becomes the keyword when considering communication between medical professionals. There are various forms of collaboration, such as collaboration between multidisciplinary, between experts and generalists, and between hospitals and clinics.

Recently, the quality of the palliative care in Japan has improved due to the cancer control act, workshop on palliative care and enhancement of palliative care units and home palliative care, and so on. On the other hand, it is also true that there are differences in the quality of palliative care and cancer care provided between regions.

We are doing a comprehensive palliative care plan in Okinawa in order to solve these problems based on the four pillars; ‘widen’, ‘heighten’, ‘deepen’ and ‘collaborate’ palliative care. We introduce this plan as it will be useful for community building on palliative care. Concretely, we promote basic palliative care throughout the prefecture（=‘widen’） and raise the level of medical professionals who play important role in community palliative care（=‘heighten’）. Furthermore, we promote the integration of oncology and palliative care at a specialized level（=‘deepen’）. Based on these actions, we promote multidisciplinary and regional cooperation, and we expect that these actions will lead to develop the community-based palliative care for a dignified and secure society under qualitative and quantitative communication.

To create a society where people can feel safe and live with dignity is defined as one of the overall objectives of the third-term Basic Plan to Promote Cancer Control. Five sectorial measures were initiated to achieve the goal under the category of “Living with Cancer.”.

Maggie's Tokyo was founded in 2016 based on the model of Maggie's Cancer Caring Centres, which originated in the UK in 1996. This article discusses the following three topics: 1) the process of creating Maggie's Tokyo, 2) our challenge to facilitate a new style of consultation support for cancer patients and their families, which has been limited in the conventional cancer care, and 3) the significance of offering such assistance outside hospitals based on our three years of experience.

Maggie's Tokyo has come to serve as a place to promote shared-decision making. We have been witnessing how not only cancer patients and their families but also medical professionals become liberated, through the collaborative effort, from the belief that they have to discuss necessary information and reach a decision within a short time. The process can contribute to maintaining a high quality of nursing practice as well as increasing the motivation of nurses. It will be even more important to actively start presenting the findings of our practice to the public.

Running the organization while providing free drop-in support is challenging itself. However, Maggie's Tokyo embracing the power of architecture and space has been attracting the attention of professionals from both medical and non-medical fields.

Cancer Control Act was enacted in 2006. Voices of patients and families were one of the driving forces. Ten years later, the basic principle of the revised law includes articles that aim to build a society where patients with cancer can live with peace of mind while maintaining their dignity. It also aims to improve social environments so that patients can receive not only appropriate cancer medical care but also welfare support, educational support, and other support depending on their situation. As cancer care and the environment surrounding cancer patients change dramatically, it is important for patients to correctly select treatment methods and living information in order to “live with peace of mind while maintaining dignity.” Hence, communication support is essential. Peer support, which is support from parties to parties, plays an important role in medical communication. In Ehime Prefecture, we, patient support group “Orange no kai” is engaged in peer support activities in cooperation with the government and medical institutions. We created a question promotion tool “Everyone's question note” and manage “Machinaka Salon for patients facing cancer” where the parties can talk freely outside the hospital. We value the process of thinking together about what the worry or puzzle is and seeking a path to a solution in the light of our experience. The role that communication from the perspective of the parties plays towards “a society where people can live with peace of mind while maintaining dignity” is considered.

Over the past few decades, the traditional paternalistic model of the patient-provider relationship has gradually shifted toward one involving mutual participation in which patient autonomy is respected and information and decisions are shared between the patient and healthcare providers. With an increase in chronic diseases, facilitating patient engagement in healthcare has been considered as a key to successful disease management and a priority on the policy agenda. In cancer consultations, which are often characterized by a higher degree of medical uncertainty and risk, the importance of SDM has been recognized from early on. With an increase in media reports and rapid diffusion of the internet, patients’ own skills in finding and applying information on health issues may have a substantial impact on their future well-being. SDM could be an opportunity to include and empower those who are normally disengaged and marginalized by improving the communication in healthcare, which may in turn reduce health inequalities.

In the present study, we discuss the possibilities of studying and practicing communication to promote health with a perspective based on evolutionary biology. According to this viewpoint, human behaviors have proximate and ultimate factors. Although health communication research have focused on proximate factors using behavior change theories and models, proximate factors are only a part of the complex of factors influencing human behavior. To study human behavior entirely, ultimate factors should also be considered. Human minds and behaviors have evolved through natural selection to solve problems associated with survival and reproduction. Humans have needs for survival and reproduction, and by inference, social cooperation and competition. These are the fundamental needs pertaining to the level of ultimate factors for humans. Studies of modularity of mind and dual-process theories of cognitive functioning have shown that fundamental needs affect decision making and behavior. Based on these previous studies, we propose what and how to communicate to support individual and community decisions that enhance health, and implications for cancer control.