Background: Although practicing advanced care planning (ACP) has recently been recommended, little is known about physicians’ practice of ACP, and barriers to ACP in Japan. We aimed to clarify the proportion of physicians practicing ACP and explore barriers to ACP. Methods: We conducted a cross-sectional survey among physicians at a tertiary hospital (934 beds) in 2019, and asked them about their practice and awareness of ACP as well as beliefs regarding end-of-life discussions. A multivariate logistic regression analysis was conducted to explore barriers to their practice of ACP. Results: In total, 90 of 186 physicians responded (response rate, 48%). Forty-two (46%; 95% confidence interval=37-57%) reported that they practiced ACP. In multivariate analysis, determinants of “not” practicing ACP included the lack of awareness of ACP and physicians’ greater beliefs regarding the lack of resources as well as the lack of time and perception of burden. Conclusion: Even at the tertiary hospital, only less than a half of physicians practiced ACP, and the lack of their awareness of ACP and various beliefs served as barriers to their practice. Initiatives to raise awareness of ACP and optimize the management to ensure sufficient time and resources for physicians may be promising to promote ACP.

Objective: The purpose of this study is to clarify the characteristics of cases where decision-making is difficult and how the medical staff can deal with them in the medical field. Method: Seven oncology physicians were interviewed. The survey items include cases where decision-making is difficult, how to deal with them, and decision support. Category analysis was performed based on verbatim records. Results: First, the cases where decision-making is difficult were divided into two categories: patient factors and environmental factors. The former is further divided into two subcategories: “personal factors” include personality and, intellectual ability and “factors due to diseases and aging” that included flailing of body parts and dementia. Further, there were three categories of medical staff’s strategies: assessment, response skills, and environmental approach. Discussion: In providing information to patients, it is necessary to respond according to the patient’s intellectual state environmental factors to promote understanding. Specifically, it is effective to use patient-specific explanations, target planning, and nudges.

Objective: This study aimed to investigate Japanese cancer patients’ perceptions of the scope of palliative care and factors that affect those perceptions. Methods: An anonymous, self-administered questionnaire was distributed to hospitalized patients and outpatients in designated cancer care hospitals in Japan. Data were first summarized using descriptive statistics. Then, using a χ² test followed by multiple logistic regression analysis, we compared patients who recognized palliative care as terminal care with those who viewed it as care that is relevant earlier in the disease course. Results: Of 3,622 questionnaires, 1,981 were completed (response rate: 54.7%). A total of 1,187 (59.9%) respondents perceived palliative care as care that could be implemented early in the disease course, whereas 414 (20.9%) respondents perceived palliative care as only relevant for the end-of-life stage. Respondents who had received palliative care for symptoms were significantly less likely to recognize it as terminal palliative care only than those who perceived that they were not the subject in the scope of care for symptoms. A diagnosis of advanced cancer and being under 40 years old were factors significantly related to the perception of palliative care as terminal only. Discussion and Implications: Our findings suggest that health care providers should be conscious of the possibility that palliative care practices affect patients’ perceptions of palliative care. Providing information about palliative care before occurring painful symptoms can help promote patients’ access to and understanding of it.

This study sought to evaluate how a training program on spiritual care affected physicians’ confidence, self-reported practice, and attitudes in caring for terminally ill cancer patients who express meaninglessness in living. Questionnaires were distributed to participating physicians before and after the training program. A total of 30 physicians completed the program. Confidence and self-reported practice regarding communication with terminally ill cancer patients who express meaninglessness significantly improved after the training: effect size, 1.3 (P=0.0001) and 1.2 (P=0.0001), respectively. Moreover, physician-reported helplessness significantly decreased (effect size, 0.8; P=0.0001) and positive appraisal and willingness to participate in caring for terminally ill cancer patients experiencing meaninglessness significantly improved (effect size, 0.8, P=0.0001; effect size, 0.4, P=0.0001, respectively). Overall, 96–100% of the participating physicians reported the program was useful for understanding the concept of spiritual care and for learning a practical approach for caring for such patients.

Purpose: This study aimed to implement an end-of-life care simulation that was assessed at one facility (University A) on nursing university students in a different educational environment (University B), and assess the simulation through a review. Method: After the simulation, participants were asked to freely comment on the review sheet and the contents were analyzed. There were 12 participants. Results: Comments on the review sheet were summarized in 13 categories: self-understanding of nursing, realization of one’s positive view regarding nursing, acquisition of knowledge regarding communication, acquisition of knowledge regarding end-of-life, gaining learning opportunities, realization of effects from debriefing, positive change one experiences regarding nursing, acquisition of knowledge regarding nursing, realization of reality, assessment of teachers’ involvement, assessment of implementation method, assessment of the atmosphere of the venue, and assessment of experiences. Conclusion: Participants of the simulation can be expected to gain a similar learning experience regardless of the learning environment.

Background: In Japan, a nation-wide education program for primary palliative care (the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education: PEACE) was established in 2008. In 2018, this program was revised from a two-day workshop to a hybrid program combining e-learning with a one-day workshop. This study aimed to assess the changes in participant knowledge and difficulties after having completed the revised education program. Methods: The subjects of this study were all participants who completed the revised program from April 2018 to March 2019. We conducted a pre-post survey via the e-learning system, and measured scores on the palliative care knowledge questionnaire to evaluate PEACE (PEACE-Q) and Palliative Care Difficulties Scale (PCDS). Results: A total of 11,124 participants completed the revised program from June 2018 to March 2019. Participants’ knowledge improved significantly according to the PEACE-Q with a total score of 24.1 and 30.0 (p<0.0001), and difficulties diminished as indicated by the PCDS with a total score of 45.2 and 39.2 (p<0.0001). Participants in different professions obtained similar results. Conclusion: Participants’ knowledge and difficulties improved after the revised nationwide primary palliative care education program. Similar results were obtained by participants in different professions.

Aims: This study aimed at investigating the status of polypharmacy and the experience and perception of bereaved family members of patients with advanced cancer regarding the burden of oral medication. Methods: Self-administered questionnaires were mailed to 303 bereaved family members of patients with advanced cancer, and 102 valid responses were analyzed (response rate, 33.7%). Results: The number of patients in the polypharmacy group (patients taking six or more tablets at a time) was 65 and that in the non-polypharmacy group (patients taking less than six tablets at a time) was 37. The percentage of bereaved family members who felt that the oral administration burden of patients was significantly higher in the polypharmacy group (43.1% vs. 10.8%, p<0.01). The results of the analysis indicated that the bereaved families wanted to reduce the number of tablets taken at a time for alleviating the burden of polypharmacy. The bereaved families of patients in the polypharmacy group were greatly concerned that the number of oral medications was too large. They also expressed the need for medical staff from whom they could seek explanation and counseling regarding the oral medication of patients. Conclusion: It is suggested that medical staff need to be fully aware of the concerns of patients’ families regarding drugs besides checking the compliance status.

Although there have been studies reporting the efficacy of palliative radiation in treating liver tumors, there are very few reports in Japan. Therefore, this study aimed to evaluate the effect of palliative radiation on pain in patients with liver tumors. Between December 2014 and November 2016, 15 patients received palliative radiotherapy of 8 Gy in a single fraction for primary or metastatic liver tumors. Among them, 12 patients were assessed for pain before and after the radiation therapy using the Numeric Rating Scale (NRS). A decrease in the NRS score post radiation therapy was reported in all cases. No grade 3 or higher acute phase adverse events were observed. In conclusion, palliative irradiation managing pain due to liver tumors is possibly effective in relieving pain and well tolerated.

The purpose of this study was to evaluate the pilot usability used in a telenursing-based cancer pain monitoring system. Health care providers and advanced cancer patients who visited a hospital as outpatients (n=10/group) used and evaluated the system using a Web Usability Scale (WUS) and free description. Of the WUS seven factors, “comprehensibility” and “content reliability” received good evaluation, and “ease of operation”, “visual effects”, “responsiveness”, “usefulness”, and “acceptablity” didn’t received good evaluation. In the free description, the system was evaluated to enhance self-management of cancer pain, a request for expansion of operation, and social issues were shown. Improving patient usability is an issue, and sufficient orientation is required to verify the effects.

Objective: This study investigated prognostic factors of short survival in patients with malignant pleural mesothelioma (MPM) upon the time of their admission to the Palliative Care Unit (PCU). Method: We conducted a retrospective review of the medical records of 12 patients with MPM, who died at the PCU of our hospital from January 2016 to April 2018. According to the classification of survival period by previous predictor model, these patients were classified into three Groups, Group A: less than 13 days, Group B: between 14 and 55 days, and Group C: more than 56 days. Results: The number of patients was 5 in Group A, 5 in Group B, and 2 in Group C, respectively. Hemoptysis was seen in 40% of patients of Group A only and oxygen inhalation was necessary for all the patients of Group A. Dysphagia and bilateral pleural involvement were seen in 80% of Group A and in 60% of Group B. Pneumonia was seen in 60% of Group A and in 20% of Group B. The above four factors were not seen in Group C. Conclusion: This preliminary study suggests that hemoptysis, dysphagia, bilateral pleural involvement, pneumonia, and oxygen inhalation are possibly prognostic factors of short survival of patients with MPM upon their admission to PCU.

Introduction: Antiepileptic drugs were occasionally administered to manage seizures in terminally-ill cancer patients. When enteral route is no longer feasible due to dysphagia or depressed level of consciousness, subcutaneous route could be an option. We reported three cases of terminally cancer patients who received subcutaneous levetiracetam (LEV) due to an inability to administer via intravenous route. Cases: The age of 3 cases was 83, 75, 82 years, respectively. In all cases, the prognosis prediction at the start of subcutaneous LEV was about 1 month. In all cases, the route of administration of LEV was changed from intravenous to subcutaneous. No exacerbation of convulsions, or injection site reaction was confirmed after subcutaneous LEV administration. Discussion: We believe that subcutaneous LEV administration may be one of the treatment options for seizures in patients with terminal cancer for whom intravenous administration of LEV is no longer feasible.

Introduction: We report a case in which multidisciplinary treatment including palliative radiotherapy reduced the size, exudate production and symptoms of a sebaceous carcinoma that had been neglected and allowed to form into a large destructive lesion. Case: A 48-year-old unemployed man who lived alone, was estranged from his family and socially isolated presented with a cranial tumor which had been present for three years. He did seek medical attention on one occasion. But a definitive diagnosis was not made, and he neglected to seek further treatment. The tumor became very large, painful and began to ooze exudate, and the patient became unwell with difficulty mobilizing. He was transported to the hospital by ambulance. The tumor was centered on the vertex of the scalp and had a maximum diameter of 30 cm. It was diagnosed pathologically as a sebaceous carcinoma and was inoperable. The tumor was treated with palliative radiotherapy, a total dose of 27 Gy　　/　　9 Fr, causing it to shrink by approximately 30% and markedly reduced the rate of exudate production. His condition improved markedly and he was able to go out on leave. Discussion: This case highlights the management and clinical course of an uncommon and large cranial sebaceous carcinoma.

Purpose: To clarify the global research trends and future directions on the sexuality of patients with ovarian cancer. Methods: Using PubMed, CINAHL, and Igaku Chuo Zasshi web version, articles published since 2000 were examined. Results: Thirty articles, primarily from Western countries, were analyzed. Japanese articles were not included. Research content was classified into “reality of sexual dysfunction and its influencing factors,” “reality of sexual activity and its influencing factors,” “relationship with partner and its influencing factors,” “changes in sexual attraction/body image and its influencing factors,” and “needs and care of/for patients regarding sexuality.” Discussion: Ovarian cancer is typically considered simply as a type of gynecological cancer, and studies that have focused on its uniqueness are lacking. The diagnosis and treatment of ovarian cancer can have long-term effects on the sexuality of any patients. It is therefore necessary to comprehensive nursing practices for sexuality according to the current situation of Japanese ovarian cancer patients.

Palliative care outreach in communities without specialists is important, but its effectiveness has not yet been clarified in Japan. The current study aimed to identify interventional targets of palliative care outreach in home care in a community without specialists. We conducted a questionnaire survey (five-point scale) of home care nurses’ attitudes, difficulties, and practices for palliative care among 39 nurses working at five visiting nurse stations in Tome city. Difficulties in “symptom palliation” and “communication with medical practitioners” were high. Nurses tended to have low confidence and high motivation. Items with particularly low confidence were “communication with home care physicians” and “staff support”. Practices in “communication with physicians” and “coordination with care person” were low. Our survey identified enhancement of face to face relationships and support for home care nurses to improve their skills and confidence as interventional targets for palliative care outreach.

Purpose: Distress screening is mandated by Ministry of Health, Labor and Welfare of Japan, however there is few data available on its effect in actual practice. We examined the impact of distress screening on palliative care referral at Hyogo Prefectural Amagasaki General Medical Center in Japan. Materials and Methods: We implemented distress screening on cancer patients who were given chemotherapy from February 2018. Patients were referred to the palliative care team when the physicians judged the need on the basis of the screening results or when the patients themselves wanted to receive the palliative care service. We examined the number of the patients referred to the palliative care team, then we researched the changes of the number after implementation of the screening, using the regression discontinuity analysis. Results: The distress screening didn’t increase the number of the patients who were referred to the palliative care team: the estimated difference of the number was 3.32 (95% confidence interval: −3.19〜9.82). Conclusion: We implemented distress screening at our hospital but it didn’t increase palliative care referral. Only a few studies have examined how routine screening impacts clinical outcomes. We expect our study helps to research the effectiveness of screening in each healthcare facility.