Purpose: This study was performed to compare the characteristics of home palliative care for elderly patients with cancer between age groups. Methods: The clinical records of 1,032 patients with cancer who received home medical care from June to November 2013 were reviewed retrospectively. Patients were classified as non-elderly (<65 years old), young-old (65-74 years), old-old (75-84 years), or oldest-old (≥85 years), and these groups were compared with respect to demographic characteristics, patient/family problems, outcomes, and medical care and services provided. Results: There was a higher percentage of patients with no caregiver in the oldest-old group than in the other groups (18%, p=0.014), while the young-old and oldest-old groups had a higher percentage of problems related to caregiving such as caregiver burden or absence of a caregiver (32% and 33%, p=0.002, respectively). In addition, the percentage of patients who required visiting nurses and care was higher in the old-old group (86% and 30%, respectively) and oldest-old group (89% and 35%, respectively) compared with the other two groups. Conclusion: Problems related to caregiving, such as caregiver burden or absence of a caregiver, were greater in the old-old and oldest-old groups, and a higher percentage of patients required visiting nurses and care in those two groups.

Objective: This study aimed to evaluate posttraumatic growth (PTG) from bereavement and other related factors among family members of deceased cancer patients who had been admitted to a general ward. Methods: A self-administered questionnaire was mailed to 42 bereaved family members who agreed to participate in the present study. The time from the death of their loved ones was between one and four years. Results: Of 42, 37 returned their responses. The average PTGI total score was 2.63, which was consistent with previous studies examined the scores at a general hospital and palliative care units. The PTGI was positively correlated with the emotion focus type coping, the recognition estimating support, and the emotional support. The PTGI of the bereaved whose loved ones underwent medical treatment at home was significantly higher than the score of the bereaved whose loved ones passed away at general ward. Conclusion: It is crucial to evaluate whether or not the bereaved experienced a healthy grieving process, and if they received social support. Moreover, it is important to provide the information regarding where the support is offered to the bereaved. Additionally, clinicians need to improve the support system so that the cancer patients can undergo medical treatment at home.

Purpose: We aimed to clarify the factors associated with the support for their understanding of prognosis by visiting nurses of patients with end-stage cancer likely involves a patient’s wish to die in a desired place. Methods: A cross-sectional nationwide anonymous questionnaire survey was conducted among visiting nurses at 1000 randomly selected home care agencies. Results: Three hundred seventy-four surveys were analyzed. An explanation of the prognosis with regard to daily life was provided to 27.8% of patients. Factors associated with the support given by nurses included notifying patients of a limited prognosis (odds ratio [OR], 3.22; 95% confidence interval [95%CI], 1.81-5.73), recognition of the support by the nurse (OR, 2.12; 95%CI, 1.02-4.43), nurses’ recognition of the patients’ need for a support (OR, 1.54; 95%CI, 1.08-2.21), and having experience in providing home care for at least five patients with end-stage cancer per year (OR, 1.78; 95%CI, 1.04-3.05). Conclusions: The findings suggested that promoting the aforementioned four items is necessary to allow patients their wish to die in a desired place and for visiting nurses to support for their understanding of prognosis.

Objective: The purpose of this study was to clarify the factors related to gemcitabine (GEM)-induced phlebitis. Methods: We retrospectively analyzed 400 cases of intravenous GEM administration to 50 patients from June 2014 to May 2015. We assessed the relationship between GEM-induced phlebitis and various factors including age, sex, BMI, analgesic use (NSAIDs or opioids), and GEM-administration procedures including drug formulation, dosage, and access site. Results: Phlebitis occurred in 79 cases (19.8%). Multivariate analysis indicated that sex (female), age (<65 years old), BMI (≥25 kg/m²; obesity), drug formulation (liquid), and access site (dorsal hand vein) were significantly related to the presence of phlebitis. Discussion: GEM-administration procedures should be modified in patients with these risk factors. It is desirable to apply hot fomentation and to puncture at the brachial region or cubital fossae region vein to prevent phlebitis.

Introduction: Number of palliative care team increase every year, but the quality of team might differ from each other. We developed “Self-Check Program for Palliative Care Team” to assess and improve the quality of palliative care team. We report the result of the multi-center study to assess the feasibility of this program. Methods: We underwent the “Self-Check Program” as a trial at seven hospitals in Japan in February 2016. We took a questionnaire survey to team leaders and participants to assess the feasibility of this program. Results: Fifty-two medical staffs in six hospitals accomplished this program. Time scheduling and the integration of opinions from each team members were the difficulties came up from questionnaire survey. All team leaders and 87.8% of the participants answered that this program was effective to extract and improve the problem of the team. Also 83.3% of the team leaders were satisfied with the process of planning. Conclusion: Despite some difficulties, majority of the participants considering useful, this program is considered feasible.

This study aimed to describe the conflicts experienced by the nurses who provide end-of-life care in emergency departments. We performed semi-structured interviews for 11 nurses and analyzed the data using content analysis. The conflicts experienced by nurses who provide end-of-life care in emergency departments caused by the “mixed lifesaving and end-of-life care,” “difficulty to catch of the needs of a patient and the family,” and “uncertainly of the goal of nursing care.” “Conflicts of the environment of end-of-life care,” “conflicts of an ethical principle,” “conflicts of the relationship with the family and medical team,” and “conflicts of nursing care to practice without assurance” indicated that the nurses were unable to perform their roles. “Conflicts of the view of life and death as a nurse” contributed to the psychological burden of the nurses. These findings suggest that nurses’ roles to the special requirements of the emergency department should be examined. Further, the goal of nursing care should be sufficiently examined and developed in agreement with the patients’ families and medical teams, based on the existing procedures. In addition, the psychological support of the opportunity of debriefing is important for these nurses.

Training system of palliative care in Japan has not been fully established, and young physicians’ needs for palliative care training are not nearly satisfied. We have recently conducted a nationwide survey to clarify unmet learning needs among Japanese physicians in specialty training in palliative care and the potential solutions they favored to meet those needs. Here we report findings of content analyses of free comments in the survey. Of 284 physicians, 253 (89%) responded, and 229 were eligible after we had excluded resident physicians with less than 2 years of clinical experience and board-certified palliative care physicians. The content analyses from 80 physicians (35%) identified 162 codes with respect to needs for improvement which were further classified into 24 subcategories and 9 categories (e.g., contents of subspecialty training, certified facilities, research capabilities, learning environment and methods, system of board certification, and networking). These findings may help improve specialty training in palliative care in Japan.

Purpose: To clarify the contents of nursing students’ feedback after they participated in a terminal care simulation. Method: Free description type answer sentences were analyzed qualitatively using Berelson’s content analysis. Results: Participants were 39 students. Feedback contents were divided into 334 recording units. As the result of analysis, 13 categories, including “acquisition of knowledge on communication,” “evaluation on method of implementation,” “self-understanding on nursing,” “self-positive-prospect on nursing,” “acquisition of knowledge on terminal care,” “evaluation on simulation ambience,” “acquisition of learning opportunities,” “self-positive-changing on nursing,” “effect of debriefing,” “effect of experience,” “feeling of reality,” “acquisition of knowledge on nursing” and “evaluation on faculty’s intervention” were formed. Conclusion: It was suggested that simulated patients contributed to making end of life clinical settings because the realism of the simulation had been apparent from the results. To make the terminal care simulation more developed, future studies should investigate how to give a briefing, and so on.

There is a lack of recognition regarding the negative impact of cancer cachexia on advanced cancer patients and their family members. Management of cancer cachexia should address not only patients’ physical problems, but also psychosocial burdens of both patients and their family members. Eating-related distress (ERD) is one of the most representative psychosocial burdens experienced during cancer. Summary points of palliative care and nutritional support for ERD experienced by patients and their family members are described as below. 1) Management strategies should address ERD experienced by patients and their family members. 2) If multimodal treatments reduce the negative impact of cachexia, ERD placed on patients and their family members might be alleviated. 3) The main causes of ERD experienced by patients and their family members are a lack of knowledge about cachexia, unsuccessful attempts to increase body weight, expected occurrence of the patient’s death, and conflicts over food between them. 4) Supportive, communicative, and educational interventions would alleviate ERD of patients and their family members. 5) Palliative care and nutritional support for ERD experienced by patients and their family members needs to be tailored to the severity of the patient’s cachexia, especially in cases of refractory cachexia. Since ERD can change during cancer, palliative care and nutritional support need to be tailored to each advanced cancer patient and their family.

Strong opioids are useful for managing cancer pain, and common side effects include nausea, vomiting, drowsiness, and constipation. Opioid overdose is known to cause respiratory depression and disturbance of consciousness. We observed a 79-year-old man with stage IVB hepatocellular carcinoma with metastasis to the rib and cancer-related pain being treated with strong opioids who, in spite of receiving a small dose and start volume, experienced strong nausea, photophobia, disturbance of consciousness, and miosis. Oxycodone was stopped to manage the strong nausea, and morphine was stopped to manage the photophobia. Furthermore, fentanyl patch was stopped to manage the disturbance of consciousness and miosis. He did not experience respiratory depression. Thus, photophobia, disturbance of consciousness, and miosis can appear as side effects even at small doses of strong opioids. The results reveal two important clinical issues: (1) photophobia can arise as a side effect of strong opioids, and (2) if photophobia, miosis, disturbance of consciousness arise in opioid-treated patients, they require careful monitoring.

Regional cooperation in palliative medicine involves multidisciplinary team care. It is very important for cancer patients to choose an appropriate place of stay during their end-of-life period. As the Nagoya Memorial Hospital does not have a palliative care ward, collaborating with other facilities offering palliative care and home care becomes pivotal. Therefore the Higashi-Nagoya home care social gathering was organized to improve communication and cooperation among regional health care professionals. Through discussions during this social gathering, the communication tools for cooperation in palliative care were outlined in November, 2015. We reviewed the outcome of 35 patients referred from our hospital using the communication tools for cooperation in palliative care: 25 patients were referred to chronic care hospitals including palliative care facilities, and 10 patients received palliative care at home; 23 died in the palliative care ward, 6 died at home, and 4 died at our hospital. A questionnaire survey conducted among the community health care professionals revealed that the introduction of this tool would be useful in providing accurate information on the prognosis of patients, level of understanding between the patients and their family, and patients’ views on life and death. Using the communication tool for communication would contribute to realizing seamless palliative care in the region surrounding our hospital, which would in turn lead to local team work and shared responsibilities to provide optimal palliative care.