Background：A palliative care education program based on the Cancer Control Act, namely the Palliative care Emphasis Program on symptom management and Assessment for Continuous medical Education（PEACE）, has been run in Japan since 2008. Purpose：The aim of this study was to evaluate the usefulness of PEACE for clinicalpractice. Method：Focus group interviews were conducted with 12 physicians who attended the program and were chosen by theoretical sampling. Two investigators independently performed thematic content analysis. Results：Qualitative analysis identified five main categories of usefulness of the program：（1）acquiring knowledge of palliative care；（2）acquiring skills to provide palliative care；（3）mastering an attitude of focusing on suffering；（4）acquiring knowledge about home palliative care；and（5）standardizing knowledge of basic palliative care in the community. Three main categories for program improvement were identified, namely the content and structure of the program, as well as the method of running the program. Conclusion：PEACE may be useful in providing systematic education in basic palliative care through the acquisition of basic knowledge and skills, discussion of cases with colleagues, observing good communication by other physicians, and networking in the community.

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Transmucosal Immediate-Release Fentanyl（TIRF）can be a key-drug for breakthrough cancer pain. Prescription audit is needed because there are concerns about tolerance or serious adverse events including respiratory suppression and addiction due to inappropriate use of these drugs. The aim of this audit study is to evaluate appropriateness of TIRF prescriptions, reasons of violation, and adverse events in the real-world setting. A retrospective chart review was conducted in 31 patients who had breakthrough cancer pain and were treated with TIRF. A 2-step algorithm was generated：baseline pain and administration situation of other opioid rescues. TIRF was prescribed appropriately in six patients（19.4％）. Reasons of violation were as follows：prescriptions only for using same drug with around-the-clock opioids（fentanyl transdermal patches, n＝19）, and patients could take oral medicines and use of morphine or oxycodone rescues would be preferable（n＝12）. TIRF was initiated with a minimum dose in all patients and no serious adverse events were observed. Although TIRF was used widely for breakthrough cancer pain, prescription was not necessarily done appropriately. Detailed assessment of breakthrough cancer pain and consideration of the use the other rescue medication would be required.

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Potent opioid analgesics are applicable for the treatment of severe pain, especially in cancer patients. Management of opioid-induced adverse effects is important to continue treatment with opioids because these drugs are associated with a variety of kinds of adverse effect, such as deliria and respiratory depression. However, information regarding these adverse effects in Japanese patients is limited. Therefore, we searched and analyzed a database for drug-induced adverse effects in Japan, the Japanese Adverse Drug Event Report database（JADER）, to acquire information related to the adverse effects induced by potent opioids such as morphine, fentanyl, and oxycodone. Cases with adverse effects associated with medications for palliative care were extracted from JADER, and types and frequencies of the events for each analgesic were analyzed. As a result, a lot of common adverse effects were found among the three opioids. However, the orders of their frequency differed among the analgesics. In principal component analysis, the property of morphine was intermediate between those of fentanyl and oxycodone. These findings may contribute to safe and effective pain control for patients receiving medical treatment with potent opioid analgesics.

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The aim of this study was to investigate the end of life care provided by long-term care facilities and nursing homes. A cross-sectional survey of all long-term care facilities and nursing homes in Kobe was performed in July 2013. Questionnaires were sent to 350 facilities with an 89.7％ response rate. In total, 121（39％）of respondents stated that end of life care was available, and 151（48％）responded that facilities were willing to provide end of life care for terminally ill residents. One hundred fifty-two（48％）and 183（58％）of respondents answered that facilities were available for managing residents with percutaneous endoscopic gastrostomy, and transfusion, respectively. Seventy-two（23％）of respondents reported that facilities for managing the use of narcotics were available. In conclusion, a minority of long-term care facilities and nursing homes ware available for providing end of life care for residents, though approximately 50％ were willing to do so.

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The aim of this study was to clarify the level of emotional distress experienced by bereaved family members and the perceived necessity for improvement in the care for patients who experience home care by visiting nurses.
Questionnaires were sent to 61 bereaved family members in December 2013, with 52％ responding.
Families reported their experiences as very distressing in 13％ of cases. Regarding care, 84％ of respondents believed that no improvement was needed. Determinants of high-level distress were insomnolence at the start of home care (P＝0.049); and patient choking while being assisted to eat by a family member (P＝0.018) . Determinants of high-level necessity for improvement were: feeling unsure when to call the nurse (P＝0.017).
Although the majority of families reported that no improvement was needed, we propose that desirable care for the patient and family should include assessment of the health status of family, advice regarding insomnolence, and coaching about cooking and assisting with easy-to-swallow food.

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Objective：Care Cafe® aims to remove the barriers between medical treatment, nursing, and welfare, particularly with regard to actual practice. This study was conducted to investigate the changes in local integration using the Care Cafe®. Method：Participants in Care Cafe® filled out the questionnaire before and after attending. We used the Mixed Method to compare the results. This method provides analysis on changes in“quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region”scale points, as well as content analysis on the free-opinion space. Results：The“quantify the quality of communication and cooperation”scale points increased significantly overall, as well as on the subscale. The effect size ranged form 0.32 to 0.36. We also had various successes in the content analysis of the free-opinion space, such as building face-to-face relationships in multiple occupations, that being one of the main purposes of Care Cafe®, as well as providing support, learning through discussion, and generating social capital. Conclusion：Care Cafe® may be a useful tool for improving local, multi-discipline cooperation involving medical treatment, nursing, and welfare.

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Some terminally ill cancer patients are treated with palliative sedation（PS）to alleviate their suffering. There have been very few studies in Japan investigating PS in the home. Thus, the aim of the present study was to investigate PS at home for terminally ill patients. A retrospective chart review was performed of 117 cancer patients who died at home between August 2012 and July 2014. Of the 73 who patients died at home, 24（33％）had received PS. The mean duration of PS was 4.4±6.0 days. Patients receiving PS were started on a mean dose of 12.8±6.2 mg/day midazolam；the mean dose at the end of PS was 12.4±6.5 mg/day midazolam. The primary reason for starting PS was delirium（n＝22）. PS in the home was feasible and was an essential treatment for cancer patients at home. We conclude that PS can be used safely and efficaciously to treat terminally ill cancer patients with refractory symptoms in their own home.

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The effects of a fan to reduce dyspnea have been evaluated in several trials worldwide, however, there has been no clinical report in terminal cancer patients in Japan. We conducted a retrospective chart review to examine whether a fan is useful for dyspnea in terminally ill cancer patients. We reviewed medical and nursing records and selected all patients（n＝9）who received a fan from July 2013 and January 2014. The primary outcome measure was a decrease dyspnea measured by a visual analogue scale（VAS；0＝no shortness of breath, 100＝worst shortness of breath）. There was a significant difference in the VAS score after treatment with the fan（40.2±11.8 versus 15.6±14.9, P＝0.004）. Our results suggest that a fan may help in reduces the sensation of dyspnea in patients with terminal cancer. Future prospective study is needed.

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Purpose：This study investigated the current state of medical care and home palliative care for terminally ill cancer patients in Japan. Methods：We conducted a retrospective questionnaire study of 352 cancer patients who received home palliative care from 6 specialized home care clinics and discontinued home care or died from January to June in 2012. Results：The questionnaire was answered by 290 patients〔165 men（57％）, mean age：72±13 years〕who started home palliative care after completing cancer treatment. Home visits from nurses were used by 238 patients（98％）and 95 patients（39％）used home care workers. Within a month before discontinuation of home care or death, 72 patients（30％）received fluid therapy and 127 patients（52％）received strong opioids. The outcome of home palliative care was death at home in 242 patients（83％）and discontinuation of home care in 48 patients（17％）. The reason for discontinuation was family physical and mental problems or physical problems of the patient. Conclusion：This study demonstrated the current state of home palliative care by specialized home care clinics.

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The aim of this study is to clarify the diet and complementary and alternative medicine among terminal cancer patients followed at home. A cross-sectional survey of bereaved families of 200 cancer patients who were received home care by 5 palliative care clinics in Kobe in 2014. The response rate was 66％. The average age of the patients was 74 years old. The family members received the information about diets from books, magazines, and newspaper（48％）and medical staff（46％）. The patients actively took in tea（64％）, dairy（62％）, and soy（60％）. The patient avoided alcohol（49％）, fat（31％）, and salt（31％）. The question asking the complementary and alternative medicine（CAM）, 32％ respondents answered using CAM, of which 28％ took mineral supplements, and vitamins. Due to the paucity of the evidence about the diet and CAM for cancer patients, the patient and family tend to practice the general diet therapy.

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Purpose：Although ammonia shows a high due to advanced liver failure and the development of portal vein collateral circulation, there are few reports on ammonia in terminal stage of cancer. Therefore, the blood ammonia was measured against terminally ill cancer patients were studied retrospectively. Methods：For 80 cases who were admitted to the hospital for the purpose of palliative care, measured the blood ammonia at the time of admission, we have studied cancer species, gender, age, survival period, HbA1c, albumin, aspartate aminotransferase, alanine aminotransferase, total bilirubin, alkaline phosphatase, blood urea nitrogen, prothrombin activity, estimated glomerular filtration rate, C-reactive protein, hematocrit, presence or absence of liver metastases, presence or absence of opioid, laxative use, L3 level psoas major muscle area in ammonia high-value group and the normal group. Results：Hyperammonemia in terminally ill cancer patients in average survival time 41.6 days was observed in 21.3％. The significant differences in gender and liver metastasis in univariate analysis, liver metastases were extracted in the logistic regression. Conclusion：Cancer terminally ill patients with liver metastases were significantly higher to exhibit hyperammonemia in this study.

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Objective：The aim of this study was to investigate the current status of home care provided by hospitals and clinics in Kobe City. Methods：In July 2013 a survey was mailed to a cross-section of all clinics and hospitals in Kobe City. Results：Questionnaires were sent to 1,589 clinics and hospitals and 899（57％）responded. Regular and urgent home visits by doctors were provided by 50％ and 65％ of respondents, respectively. End-of-life care for dying patients at home and in nursing homes was provided by 31％ and 18％ of respondents, respectively. The average time spent on home visits was 2.3±1.7 days per week. Care for cancer patients, participation in national palliative care lectures, and holding a discussion at the admitting hospital before discharge for home care, were performed by 23％, 7.0％, and 6.9％ of respondents, respectively. Conclusion：The majority of hospitals and clinics in Kobe City provided home care.

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The present study aimed to clarify whether positive attitudes towards terminal patients among nursing students are a）promoted by palliative care lectures, and b）more prevalent among students with experience with a relative’s death or being present during their final moments. A survey was conducted using the Frommelt Attitude Toward Care of Dying Scale, Form B, Japanese version, and scores were compared for pre- and post-palliative care lectures and experience of being present during someone’s dying moments. Responses were obtained from 69 students. Scores for positivity toward care for terminal patients and awareness of patient- and family-centered care were significantly higher after the lectures（p＜0.0001）. No significant difference was observed between scores based on whether they had experience of being present during someone’s dying moments however, scores tended to be higher for students with these experiences. The present findings suggest that palliative care lectures including content related to terminal care are useful for promoting positive attitudes towards terminal patients among nursing students.

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Objective：The previous study was to develop the“Itamikei”, a small machine which patients can use to record their subjective level of pain. And new assessment tool“Tablet PC application for Pain Memory”, which enable the user to visualize and record the pain levels both instantly and over time. The purpose of this study was to examine the effectiveness of Pain Memory as a pain assessment tool for patients with cancer pain. Method：12 inpatients prescribed analgesics for cancer pain, were instructed to input their pain level into Pain Memory over a 2-week period, and the resulting graph was reviewed by the patient and staff. They also completed a questionnaire evaluating the design, function and pain assessment of the tool. Result：The patients input their pain level into Pain Memory 5.25 times／day（Md）, which provided increased opportunities to ascertain the patient’s pain level compared to that“Itamikei”. The design and function of the Pain Memory were given approximately rate 4 using a 5 point scale by both patients and staff members. Moreover, using Pain Memory, the patients highly rated the parameter“I understood changes in pain”, and the staff members highly rated the parameter“Patients participating in the treatment of pain”. Conclusion：We found Pain Memory could be useful in the assessment of pain. It provided more opportunities to ascertain the pain level of patients, and enabled the visualization of the pain level through a graph.

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The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

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Objective：There are few reports on decision-making support at palliative care clinics in designated regional cancer care hospitals. This study clarified the types of decisionmaking support patients with cancer and their families were provided by specialized outpatient palliative care services. Method：We retrospectively examined the medical records of 110 patients who had been referred to the palliative care clinic for home care between April 2012 and March 2014. Results：The median duration of receiving services from the palliative care clinic was 23 days（range：1～492 days）. The mean number of visits to the clinic was 4.7 visits（range：1～29 visits）. A total of 89 patients（80％）needed decision-making support. Of those 89 patients, 33（30％）required support in making a decision about anticancer treatment. Twenty-six（78％）of those 33 patients had just received the diagnosis or were receiving anticancer treatment. Conclusion：The study suggested that decision-making support in early stages is an important role for a palliative care clinic in a designated regional cancer care hospital.

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Purpose：The purpose of this study was to clarify the practice of acupuncture and moxibustion in medical institutions with a palliative care unit. Methods：A selfadministered questionnaire was mailed to the physicians in charge of the ward or the chief nurses of 244 medical institutions with a palliative care unit. Results：Responses were obtained from 98 institutions. Among these, it was obvious that acupuncture and moxibustion therapy were performed in six institutions（6.1％）. The conditions of patients treated with acupuncture and moxibustion were pain, fatigue, constipation, and displeasure. Regarding acupuncturists being concerned with a palliative care field, it was described that acupuncturists could have one of the important role in clinical field in palliative care. On the other hand, it was indicated that there were difficulties associated with the practice of acupuncture and moxibustion therapy in a hospital. Conclusion：Although acupuncture and moxibustion therapy are considered to have usefulness as a variety of care, to practice acupuncture and moxibustion therapy in a medical institution, it is necessary to examine create the practice system.

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Ifenprodil, NMDA receptor antagonist, was very effective in the treatment of 3 patients with severe trigeminal neuralgia. Patient 1：A 70-year-old female had been treated for macroglobulinemia in our hospital. She had been suffered from severe trigeminal neuralgia for more than ten years. Carbamazepine given in another hospital was ineffective. We gave ifenprodil to her and it reduced her pain within 4 weeks. However, her pain relapsed after 1.5 years, so we gave pregabalin instead of ifenprodil to her. Patient 2：A 89-year-old male had been treated for myelodysplastic syndrome in our hospital. He also had been treated for trigeminal neuralgia in another hospital. Carbamazepine was ineffective and nerve block relieved his pain temporarily. We gave ifenprodil to him and it reduced his pain within 2 months. Patient 3：A 62-year-old female was referred to our hospital for the treatment of trigeminal neuralgia. She had been suffered from severe pain for about 10 years. She had taken carbamazepine with no effect. We gave ifenprodil to her and it reduced her pain within 4 weeks. Ketamin, non-selective NMDA receptor antagonist, is known to be effective in neuropathic pain, but it has various side effects. Ifenprodil, specific NMDA receptor subunit NR2B antagonist, may show better separation between efficacy and side effects.

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Case report：A 69 year-old man with an end-stage lung carcinoma had difficulty to come to our out-patient clinic due to severe pain and familial reasons. The reports from his sister were limited and his condition seemed no improvement. A certified palliative care pharmacist visited his home to assess his current status and situation in detail in order to provide better care for him. Result：Direct and accurate assessment of his pain status and compliance to his medication allowed our palliative team to provide tailored instructions and alleviate his suffering. Home visit helped to create better communication between the patient and the team and relieve his anxiety. The information from the visit provided his doctor with objective assessment of his current situation, which resulted in tailored prescriptions. This whole process was also effective to his smooth admission when he finally deteriorated. Summary：Home visit assessment and management by hospital pharmacists was very useful to the patients who have difficulty to come to the clinic by improving his quality of home life and sharing his social and clinical information between the out-patient clinic and the hospital. The home visit can be a good option for such patients.

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Malignant psoas syndrome（MPS）is one of challenging cancer pain states, which is often refractory to conventional analgesic therapy. We report a case of a 67 years-old female patient suffering from left MPS caused by lumbar paravertebral malignant lymphoma. Tapentadol, a dual action analgesic, has relatively low affinity to mu-opioid receptor and provoke noradrenergic reuptake inhibition simultaneously. Neuropathic component is predominant in MPS. Tapentadol is reported to be a drug of choice for the treatment of neuropathic pain. Psoas compartment blockade is a choice of interventions to relieve severe thigh pain caused by a lesion of lumbar plexus which exists in a compartment between psoas and quadratus lumborum muscles. Pain and numbness in the affected left thigh region of the patient were well managed by opioid switching from oxycodone to tapentadol and supplemental psoas compartment blocks with a local anesthetic and dexamethasone. The activity of daily life and quality of life of the patient were dramatically improved. Tapentadol with psoas compartment blockade may be efficacious for the management of MPS.

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Purpose：Chronic cough is one of the symptoms that lead to a reduction in the quality of life insomnia, such as the decline in physical strength. For chronic cough due to metastatic lung tumors, and we experienced an example of after use pregabalin, showed a reduction of symptoms. Case：This case is a 75-year-old man. Abdominoperineal rectal amputation was performed in rectal cancer. Adjuvant chemotherapy has been performed, but multiple lung metastases appeared one year after surgery. Chemotherapy was continued, but lung metastases progressed, it became the policy of anti-cancer treatment ended 4 months after 2 years after surgery. Cough worsened since then, it was referred introduced to palliative care department. Because we thought respiratory tract irritation increased by organic disease is the cause, it starts from 50 mg／day pregabalin, it was increased by 25～50 mg while aware of potential side effects, such as drowsiness during the day. Cough relief at 125 mg／day, night sleep wasalso secure and possible. Conclusion：Pregabalin which is effective in neuropathic pain, there is a possibility that the suppression of hyperexcitability of nerve cells that are its pharmacological action, is also effective in chronic cough, it becomes choice of antitussive different mechanisms of action and opioid there is a possibility that may.

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Case：A 57 year-old man, who had received home oxygen therapy and noninvasive ventilation（NIV）as outpatient, was admitted to our hospital because he felt shortness of breath. He could not eat meals because he was required to receive NIV in all days. He therefore was admitted to our palliative care unit（PCU）on a permanent basis in order to improve the quality of his life. In the PCU, he could take a bath, eat meals and appreciate local folk songs while receiving NIV. Complications were only desaturation and feeling shortness of breath while bathing or eating. Conclusions：NIV may be a useful device for the patients with terminal respiratory failure.

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Case 1: A female, aged 81 years, with cardiac stomach cancer. Air retention in the digestive tract aggravated discomfort of the epigastric region, but belching relieved the symptom. As belching insufficiency persisted, the continuous subcutaneous injection of metoclopramide was started. Belching was promoted, and swelling of the upper abdomen was relieved. Case 2: A male aged 57 years. Gastrointestinal obstruction related to pancreatic head cancer was observed. He complained of discomfort of the upper abdomen with abdominal swelling. Belching reduced these symptoms. The continuous subcutaneous injection of metoclopramide facilitated belching, and relieved discomfort of the upper abdomen.Discussion： The results suggest that the continuous administration of metoclopramide is a useful option for belching insufficiency associated with cancer-related gastrointestinal obstruction. In the presence of gastrointestinal obstruction,gas retained in the stomach may be elevated/regurgitated through the peristalsis-promoting actions of metoclopramide,promoting belching.

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In our medical district, home care physician-led liaison system has not yet been established for pain relief using a patient-controlled analgesia（PCA）pump. Therefore, it has been difficult to perform continuous opioid infusion at home. We investigated the liaison system based on our experience with breast cancer patients in whom oral drug administration became difficult during palliative care at home and thus continuous opioid subcutaneous infusion was started in cooperation with a palliative care hospital team and based on the discussion among home care study group physicians of the medical association. Based on the results of our study, we established the system called“Home PCA Raku-raku（Easy）Pack”that are characterized by the following：（1）opioids are prescribed by a home care physician；（2）a certified cancer pain management nurse accompanies a nurse to visit the patients’ home, assesses their conditions, and changes the drug solution；（3）the pump rental fee is paid by the home care physician, and the cost of consumables is paid by the hospital；and（4）the home care physician calculates the fee for home management of malignant tumors, and the hospital calculates the collaborative medical management fee and the visiting nursing management fee. This system was applied to 6 patients during a period of approximately 2 years. The result of a questionnaire survey for home care physicians and visiting nurse stations using this system showed that the system was generally beneficial.

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Introduction：There are various problems in order to perform the Animal-Assisted Therapy（AAT）in the Palliative Care Unit（PCU）of a general hospital, a manual for carrying out is required. Methods：In our hospital PCU, implementation manual has been created by the cooperation of university of research institutes, health center of administrative agency, and the infection control team of our hospital. Results：1st AAT was held in February 2011. Then, at a pace of once a month, AAT was held a total of 35 times until March 2013. During the AAT, therapy dog, handler, doctor, nurses, ward volunteers, health center veterinarian played the role of each as a team. The evaluation meeting held after, in addition to the evaluation and reaction of participants, evaluation of environmental health and compliance with procedure were also performed, implementation report has been submitted to the health center. Discussion：In order to perform the AAT in PCU in general hospital, there are problems such as infection, environment and health. In the practice, by obtaining cooperation experts each, it was possible to create an implementation manual by perspective multicenter multiple sectors. This manual would be helpful to perform the AAT in each facility.

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Palliative care team（PCT）, nutrition support team（NST）and office of nutrition in our hospital developed a special soup service, which was served for ten patients faced with terminal cancer. The members of PCT, NST and the Cook served a special soup to ten patients. Nine of them could taste the soup without vomiting although they had anorexia. It was a good result. The number of days from the last day tasting the soup to death or hospital transfer was between 3 and 20 days（12.5 days on average）, and the number of times they could taste the soup was between 1 and 3（2.0 times on average）. Tasting the soup supports the strength of living, and might bring an improvement in spiritual quality of life.

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Compared with the increase of cancer patients, there is insufficiency number of beds at palliative care unit(abbreviated to PCU)and hospice. To utilize them as medical resource efficiently, it is necessary to assess the condition of patients and to decide the order of admission fairly and impartially. The appropriate way of decision is also a prerequisite of the facility criterion of hospice by the Ministry of Health, Labour and Welfare and one of the evaluation items of palliative care by Japan Council for Quality Health Care. Many PCUs and hospices declare that a conference for the hospitalization judgment is held regularly, although few hospitals disclose the process of decision and its criteria of the order of priority. We made a checklist for the judgment of hospice admission in which the needs of hospitalization are converted to the numerical value in terms of patient's willingness, condition, context and prognosis. The checklist was introduced in our PCU in September 2012. In 2013 fiscal year, the conference for the judgment of PCU admission was held almost once a week(51 times)and the total number discussed were 403 cases(7.9 cases per one conference)and those who were actually hospitalized were 187 patients. The imbalance shows the necessity of the fair and impartial decision.

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Purpose:This study aims to clarify the current situation where palliative care is concurrently performed with cancer therapy, and its effectiveness. Methods:Medical charts of patients cared for at home between April 1, 2012 and March 31, 2013 were retrospectively investigated. Results:14 out of 192 home-care cancer patients were given chemotherapy. The palliative medication period was 192 days and chemotherapy lasted 89.8 days on average. From the beginning of home palliative care until death, patients received chemotherapy for almost half of this period. Consideration:By establishing trust between patients and caregivers, palliative care serves the patients needs well, even after cancer treatment is completed. Home palliative care is a significant part of the entire process.

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For the purpose of relieving stress caused by post operative change in diet due to gastric cancer, a cancer salon which included a cooking class collaborating with doctors, oncology certified nurse specialist, NST registered dietitian, cancer support center nurse, and cook was held. The cancer salon was intended for post gastrectomy patients and their families. There were total of 20 participants（12 patients, 8 families, 8 males and 12 females）, and among them were six couples. We conducted a questionnaire survey of cancer salon to participants whose average age was 64±13.4 years old. All participants responded“good”or“fair”in all items. Among respondents, 61％（n＝11）said it was fun, 88％.（n＝15）said“cooking in the cooking class would be helpful in the future”. Not only learning how to cook, the salon provided an opportunity for participants to interact with each other and exchange information. In addition it helped participants to realize that there are others having the same disease who want to exchange opinions and the disease is not a problem of an individual rather it exists more universally.

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[in Japanese]

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