Few studies have been performed to examine the effects of educational intervention for oncologists in Japan, to update their knowledge and skills regarding palliative care. This study is aimed to evaluate not only the improvement in trainees’ knowledge and self-complacency, but also to focus on the factors associated with the actual clinical practices of trainees. In one year, 323 trainees from the Hiroshima prefecture joined palliative care workshop using the Palliative Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE), and they were included as subjects in the present study. Referring to the contents of the program, a questionnaire was developed to estimate the extent of change in the trainees’ attitude towards clinical practice. Each of the 26 items included a five point Likert scale ranging from “mostly take responsibility for symptom management” to “depends mostly on the experts for direct intervention”. The questionnaire survey was conducted before and after the implementation of the PEACE program. From the 206 valid responses, most of the data items showed a significant and positive shift in the trainees’ attitude toward palliative care in a clinical setting. Items that did not show this change pertained to adjustment of antidepressants and tranquilizers for delirium and depression. These results suggest that the PEACE program may be effective in improving physicians’ attitudes regarding palliative care.

Clinical decisions on infectious diseases in terminally-ill cancer patients are often made based on physicians’ and nurses’ personal medical experiences, which may lead to an intra-team conflict. We conducted a qualitative analysis with prospectively gathered, semi-structured interviews in order to identify physicians’ and nurses’ beliefs and perceptions contributing to the variabilities in their attitudes toward patient care and the conflicts during decision-making process. We obtained the following categories with respect to beliefs and perceptions: estimated prognosis; patient’s discomfort due to tests and treatment; agreement to physician’s treatment plan; patient’s and family’s wish for tests and treatment; and patient’s benefits by tests and treatment. The intra-team conflicts resulted from disagreement on patient’s condition, and difficulty understanding mutual intent or opinion among physicians and nurses. Our findings may help improve team-based communication and the quality of care in terminally-ill cancer patients with infectious diseases.

In order to understand the current status of terminal care for cancer patients and to investigate the significance of palliative care units (PCUs), we reviewed 414 cancer patients who died at our hospital during the 2-year period since October 2013 (PCU: 219 patients, general wards: 195 patients) based on their history of anticancer therapy and use of palliative care. Compared with PCU patients, those in the general wards were older, the diagnosis was delayed, and disease progression was more rapid. It was suggested that these factors had a negative impact on the opportunity to receive standard anticancer therapy and palliative care. Among the patients who received chemotherapy, the median interval from the final treatment to death was 110 days for those in the PCU while it was significantly shorter (55 days) for those in the general wards. Chemotherapy was administered within 1 month before death to 2% of patients in the PCU versus 32% of patients in the general wards, so the rate was much higher among the latter patients. In order to provide appropriate terminal care for cancer patients, the PCU seems to be important. Irrespective of the timing of cancer diagnosis and progression, it is important to increase general social awareness of palliative care and advanced care planning in order to promote the use of palliative care strategies.

Periodic evaluation of end-of- life (EOL) palliative care is important to maintain and improve quality of EOL palliative care. We conducted a cross-sectional, anonymous, self-report questionnaire survey for bereaved family members of cancer patients in 2010. This was the second time nationwide survey. This study aimed to evaluate EOL cancer care from the perspective of bereaved family members in nationwide general hospitals, inpatient palliative care units (PCUs), and home hospices in Japan and to explore whether there is any change of quality of palliative care over the last nationwide survey conducted in 2007. Among member facilities of Hospice Palliative Care Japan, 25 general hospitals, 103 PCUs, 14 clinics participated in this study and 7797 bereaved family members answered the questionnaire. Overall, bereaved family members were satisfied with EOL care in all places of death, as in the last survey. Although results indicated that coordination of care and physical care of nurse were warranted to improve in general hospitals, drawback of PCUs were availability and the potential deficits of clinics were the environment. Through the years, there is no clinically significant change from the last survey. We should continue to make efforts to evaluate and monitor palliative care in Japan for quality control.

Purpose: To develop a hematological cancer nursing difficulty (HCND) scale and analyze its reliability and validity. Methods: Self-reported questionnaires were distributed to nurses who were engaged in hematological cancer nursing. Results: As a result of explanatory factor analysis, six subscales comprising 35 items were extracted, which are as follows: to provide psychological support and decision making for patients and their families over a long period of time, understand the treatment and pathology of a variety of hematological cancers, alleviate the symptoms caused by chemotherapy and deterioration of the patient’s general condition, collaborate with physicians, manage the symptoms of the complications that occur after hematopoietic stem cell transplantation, and support the selection of the location and achievement to get end-of-life care. The reliability of the scale was confirmed using the Cronbach’s α coefficient of 0.96 (0.84‒0.94 for subscales). The criterion-related validity was confirmed by comparison with the 49-item Nurses’ Difficulty with Cancer Care (NDCC) scores. In terms of the validity of known groups, the HCND score for the nurses who were engaged for over 4 years in hematological cancer nursing was significantly lower than those who were engaged for less than 4 years in hematological cancer nursing. Conclusion: The reliability and validity of HCND were confirmed. Therefore, this scale may contribute in determining outcomes of educational or organizational interventions.

Objective: This study aimed to (1) understanding the activities, job satisfaction, and burn out of certified nurses in palliative care, and (2) develop suggestions for increasing job satisfaction and preventing burnout among these nurses. Methods: Questionnaires were sent to 362 certified nurses in palliative care in 2008 with a series of questions on their background, activities, job satisfaction, and burnout according to the burnout scale. Results: Logistic regression analysis was performed on 226 completed and returned. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation questionnaires. Attributes associated with the group of respondents who reported higher job satisfaction included “higher age,” “long tenure in the job category,” and “having well-defined objectives.” The burnout group, which accounted for 44% of the respondents, was associated with the factors of “lower job satisfaction score,” “unsatisfactory working location and/or conditions,” “lower satisfaction about social recognition of their profession,” and “being unmarried.” Conclusion: Higher job satisfaction and prevention of burnout among the respondents were associated with higher age and good communication within the organizations. The findings suggest that interventions are required to support nurses who are younger and face difficulties in communication within the organizations.

Purpose: In Kasugai City Hospital, we have introduced palliative care clinical pathway with a focus on decision-making support on the intention of recuperation location in addition to symptom relief. In this study, it is intended to explore the factors that make it difficult to home discharge of cancer inpatients with the intention of discharged home on the basis of the information on the clinical pathway. Methods: The subject patients were cancer inpatients who had expressed the intention of the discharge to the home during period from June 2014 to August 2015. We examined the medical records of the target patient retrospectively. Logistic regression analysis was performed in order to clarify the factors that make it difficult to home discharge. Results: Of 43 patients, 25 patients (58.1%) were discharged from the hospital to the home. As a result of logistic regression analysis (multivariate analysis), delirium and living alone have been extracted as the predictive factors that makes it difficult to home discharge. Conclusion: Delirium and living alone have been suggested as the factors that makes it difficult to home discharge of patients who wish to home discharge. Early detection and early treatment of delirium are important, and early collaboration between the hospital discharge support department and palliative care team for the living alone patient is also necessary.

Background and Purpose: Nursing healthcare-associated pneumonia (NHCAP) causes distress and unpredictable symptoms. We investigated the frequency of comorbid symptoms and the effects of symptom relief with pharmacotherapy for NHCAP patients with advanced cancer. Methods: We retrospectively investigated the medical records of 15 patients with NHCAP who had died from January 2014 to November 2015. We investigated the frequencies of symptoms (pain, dyspnea, drowsiness, respiratory secretions, nausea, insomnia, fever, dry mouth, wheezing, and depression) and the therapeutic effects of drugs for symptom management (opiates, glucocorticoids, anti-cholinergic agents, and antibiotics). A Validated instruments (Support Team Assessment Schedule-Japan [STAS-J]) was used to assess symptom distress. Results: The symptoms of NHCAP were pain, insomnia, fever, fatigue, oral feeding difficulty, dry mouth, nausea, drowsiness, and depression. Administration of opioids was a useful treatment for dyspnea and pain. The mean number of concurrent symptoms was 4.6 ±1.8. Opioids and glucocorticoids were administrated to patients with pain and dyspnea, and these symptoms were resolved. Antibiotics were used in all patients, who were resolved their wheezing and fever, but no other symptoms. Conclusions: Patients with advanced cancer complicated by NHCAP have multiple distressing symptoms. A focus on ameliorating the most prevalent physical symptoms and psychological distress may improve overall quality of life in this patient population.

The modified Richmond Agitation-Sedation Scale (RASS) seems to be one of the best monitoring indicators for palliative sedation. We translated the modified RASS into Japanese according to the standard methods of conducting linguistic validation. The modified RASS revised two points from the original RASS for use in palliative care setting: deleted the description about the ventilator, and added some descriptions to clarify the meaning of RASS+1. In addition, we have deleted the description “rubbing sternum” in the procedure for RASS assessment, and then translated the modified RASS into Japanese. The translators and our research team members repeatedly discussed the linguistic validity until we agreed that the translated Japanese version is equivalent to the English one. The use of the Japanese version of the modified RASS to monitor palliative sedation may help to perform appropriate, and safe palliative sedation.

There are few reports on the disclosure of survival prediction to patients themselves in Japan, and how concretely it is performed. We retrospectively studied the disclosure of survival prediction to patients who were referred for the first medical examination to the Palliative Care Department between April 2013 and March 2016. Two hundred forty-eight patients (and their families) met the study criteria. Forty-three percent of the patients and their families had received information on definite periods of life expectancy without probability or ranges. On the other hand, 19% of the patients and families had not been told about survival prediction by the previous physician. Our results suggest that patients and families often received information on definite periods of life expectancy. There will be a need for improvement of end-of-life discussion in Japan.

The current authors encountered a case where administration of venlafaxine alleviated depressive symptoms and neuropathic pain in a patient with bone metastasis of lung cancer. This case involved an 84-year-old woman. The woman suffered a fracture of her right femur due to bone metastasis of lung cancer, so she was transferred to this Department. Upon transfer, pain and depression were noted. The patient was given an increased dose of extended-release oxycodone, but bone pain, neuropathic pain remained. Depression persisted. Venlafaxine was administered, and depression, bone pain, neuropathic pain were alleviated. The current case suggested that venlafaxine is highly efficacious in treating depressive symptoms and neuropathic pain in patients with cancer.

Herein, we report our experience of a patient whose recurrent pelvic cancer was complicated by obturator hernia after cervical cancer surgery. Regardless of the type of carcinoma, recurrent pelvic cancer tends to be complicated by neuropathic pain. On the other hand, obturator hernia is also often complicated by the similar neuropathic pain, which is referred to as Howship-Romberg symptom. However, it is relatively a rare disease that is considered difficult to make a diagnosis. In the case of this report, the patient had already developed neuropathic pain in the inside of the left thigh when she was admitted to our hospital, and began to develop a similar symptom on the right side during the course of follow-up. Despite the additional administration of analgesic adjuvant, the pain in the right thigh did not improve, and she began to develop heat sensation and redness in the extensive area from the thigh to the knee. CT scan revealed subcutaneous emphysema image and abscess formation. Based on the results of the examination, the patient’s right thigh was diagnosed as caused by the digestive tract incarcerated by obturator hernia rupturing into the right limb. The differentiation of obturator hernia is difficult to make, but its early stage diagnosis might make it possible to evade the aggravation of the symptom by manual reposition. In conclusion, when recurrent pelvic cancer was found to be complicated by neuropathic pain, it is critical to make an appropriate diagnosis taking into account the potential obturator hernia at an early stage.

Introduction: Though the animal assisted therapy and the animal assisted activity with animal visiting are widely introduced to general hospitals in Japan, the report of those activities in palliative care units (PCU) of general hospitals are few. Methods: In June 2013 therapy dogs started to visit our PCU with the help of NHO Japan Animal Association. We discussed on the effects and the problems as a part of the palliative care about this activity. Results: Three therapists with 3 therapy dogs came to our hospital twice a month and the total number of 487 patients took part in 73 sessions until September 2016. Those activities made the patients and their families felt better and their communications with staffs were improved. No adverse effects concerning the safety and health were observed in those activities. Discussion: The reliable training and infection control of animals can make easy the introduction of animal therapy to the PCU of a general hospital. Visiting of therapy dogs can provide the healing to not only the patients and their families, but also the staffs in the PCU.