This is a qualitative study involving physicians and nurses experienced in providing home end-of-life care. The methodology employed in this study consisted of a self-administered questionnaire distributed to 16 home physicians. The questionnaire aimed to investigate the distinctions and attributes associated with the end-of-life care process, as well as the roles they assume in this context. Additionally, semi-structured interviews were conducted with 5 home physicians, 3 visiting nurses, and 1 professional nurse. The analysis was carried out using a modified Grounded Theory Approach (M-GTA), with the overarching theme of “Enabling End-of-Life Care at Home” and a focus on the individuals involved in providing end-of-life care at home, including physicians and nurses. The results revealed that 25% of the home physicians found end-of-life care to be challenging. All participants indicated that the end-of-life care process differs between cancer and non-cancer patients. The distinct characteristics of the end-of-life care process were summarized in 16 categories. Notably, the ability to predict prognosis was associated with “cancer,” and the learning of the end-of-life care process from a practitioner was highlighted by M-GTA. The perception that “prognosis can be predicted” was commonly held among physicians but less prevalent among nurses. This difference in perception was identified as one of the factors contributing to the difficulties experienced by nurses in end-of-life care.

This study aimed to investigate the relationship between ward nursing practices from a home perspective and interprofessional work (IPW) competencies in discharge support. A questionnaire, consisting of a self-assessment scale designed to evaluate ward nursing practices with a home perspective, was distributed to 795 nurses employed in hospital wards in prefecture A. Out of these, 191 individuals responded, resulting in a valid response rate of 22.4%. The model fit was found to be adequate based on a covariance structure analysis. “Ward nursing with a home perspective” was directly influenced by “management of team activities” and the“frequency of collaboration with external interprofessional staff.” Additionally, it also had an impact on “understanding and respecting others.” The results revealed that ward nursing with a home perspective and IPW competencies had a mutually reinforcing relationship. This suggests that there is a mutually reinforcing relationship between ward nursing practices from a home perspective and IPW competencies.

The Japanese government has been promoting home medical care so that people can live in familiar surroundings even if they have diseases. This study aimed to investigate the factors associated with dying at home in Japan. A cohort study was conducted using six years of claim data from the National Health Insurance in Kanagawa Prefecture. The study population comprised individuals aged 65-74 who received home medical care in the terminal stages of cancer. The outcome of this study was the place of death (home or hospital). Of the 2,748 cases, 2,192 (79.8%) died at home, and 556 (20.2%) died in the hospital. The Modified Poisson Regression Model results identified (1) cooperative intervention between home care clinics and hospitals before the transition to home care and (2) urgent home care physicians’ visits as being significantly associated with an increased percentage of home deaths. Our study suggests that these home medical services may contribute to the policies for home medical care.

Introduction : This study aims to clarify the symptoms, complications, and treatments encountered in patients for whom senility has been determined as the cause of death by home care physicians.

Methods : A case series study was conducted via a postal questionnaire survey among medical institutions associated with the Japan Network of Home Care Supporting Clinics.

Results : We received reports on 727 cases. Complications from infectious diseases, particularly pneumonia, were common as acute conditions. Among chronic conditions, dementia was most prevalent. The symptoms frequently observed in the final week before death included anorexia and dysphagia. The most common intervention in the last week of life was “no medical intervention” from the options provided.

Conclusion : This study has illuminated the present circumstances of complications, symptoms, and treatments in patients diagnosed with senility as the cause of death by home care physicians.

Introduction : This analysis examines the factors influencing end-of-life care in home support clinics.

Methods : Within a year, cases resulting in death at our clinic were divided into those diagnosed at the clinic and those diagnosed in the hospital. Variables such as age, gender, days of intervention, cancer status, presence of a Do Not Attempt Resuscitation (DNAR) order, home versus facility care, frequency of Advance Care Planning (ACP), independence level in daily living of the elderly with disabilities or dementia, number of inquiries, number of home visits, and phone re-examinations were analyzed univariately. Factors with p < 0.20 were subjected to further multivariate analysis, with significance considered at p < 0.05.

Results : From 44 cases, 26 were diagnosed with death at our clinic. Univariate analysis showed a significantly higher frequency of ACP in these cases. Other factors with p < 0.20, such as the presence of DNAR and home versus facility distinction, only showed a significant difference in ACP frequency upon multivariate analysis.

Conclusion : The study suggests a relationship between the number of ACP sessions and cases diagnosed with death in our home support clinics.

The number of children receiving medical care at home, while using ventilators and other medical devices, is on the rise. However, there are fewer medical and social services available to support them compared to the services provided for the elderly. This places a significant burden on the caregivers responsible for children with medical needs. To alleviate this burden on caregivers, a mechanism has been developed to detect alarms from ventilators and biometric monitors and send notifications to smartphones. This development was the result of a collaborative effort involving a clinical engineer, a development company, a design company, and a coordinator. As a result of this collaboration, the product was successfully commercialized. It is believed that clinical engineers can play a vital role in the future of home medical care by actively participating in the home healthcare domain, as demonstrated in this case.