Objective: To clarify family members’ behaviors toward terminally ill cancer patients with communication difficulties and the related support provided by medical professionals. Method: Participants included 15 medical professionals engaged in palliative care (physicians, nurses, and psychologists) and 5 bereaved family members who had cared for terminally ill cancer patients at a hospital. Semi-structured interviews were conducted on the following: (1) family members’ behaviors toward the patient and (2) related support provided by medical professionals to family members. The interviews were qualitatively analyzed using category analysis. Results: We identified three categories of family members’ behaviors toward the patient such as behaviors that continue to communicate with the patient as usual, behaviors that assist patients to feel secure and relaxed, We also identified nine categories of the related support provided by medical professionals such as advising family members on how to behave with the patient and providing encouraging feedback to family members on their behaviors toward the patient. Discussion: Our results suggest that medical professionals encouraged family members to continue their behaviors to patients confidently. Support to family members included suggesting behaviors to make it easier for them to put into practice, encouraging the patient and family interaction, and giving feedback on the family member’s behaviors.

Purpose: To investigate the relationship between late effects and social distresses in head and neck cancer survivors more than one year after radiotherapy. Method: An existing subset of head and neck cancer-specific quality of life scale was used to assess late effects and social distresses in survivors who had completed radiotherapy for more than 1 year. Descriptive statistics were performed for each social distresses and symptom, and were analyzed their association. Results: Seventy-three people responded to the survey. All patients had some symptoms. The most prevalent and severe late effect was dry mouth (79.5%). In addition, the most prevalent social distress was trouble with social eating (87.7%), and the most severe was speech problems. There was a significant positive correlation between late effects and social distresses. Social distresses were associated with dysphagia and sticky saliva and a history of surgery. Conclusion: Head and neck cancer survivors may have multiple late effects and social distresses at the same time, and there are a need for a comprehensive assessment of the impact of symptoms in the outpatient setting.

Objectives: The purpose of this study was to investigate nutritional problems in cancer patients and effectiveness of Palliative Care Team Dietitians. Methods: We retrospectively surveyed cancer patients who received the nutrition support. We evaluated (1) nutritional problems and the details of nutrition support from Palliative Care Team Dietitians at the start of our intervention, (2) the degree of “Eating-related Distress” before and after our intervention using the Verbal Rating Scale (VRS), and (3) energy intake. Results: Patient age (median) was 67 years, (1) “Insufficient energy intake” was the most common nutritional problem at the start of our intervention (56 cases) and “arrangement of meal forms” was the most common intervention(53 cases), (2) dietary difficulty improved in VRS (median) 3 to 2, and (3) energy intake was increased from 753±552 kcal to 926±522 kcal/day (p<0.01) after our intervention. Discussion: The results suggested that Palliative Care Team Dietitians intervention could reduce dietary distress and increase energy intake.

Objective: The aims of this study were to (i) clarify whether there are differences between bereaved families and medical staffs in their preferences for life-prolonging treatments, and (ii) investigate the factors associated with preferences for life-prolonging treatments. Methods: Cross-sectional internet survey was conducted in October 2019. Participants are bereaved families(n=618), physicians(n=206), nurses(n=206), and care workers(n=206) who registered with the internet survey company. We asked the subjects about the relative importance of 36 components of a good death in dementia and their preferences for 7 treatment items that they might need at the end of life. Results: Statistically significant differences in end-of-life medical preference between bereaved families and medical professionals included “Nutrition from gastrostomy when oral intake is difficult” (p<0.01), “Surgery for life-threatening disease” (p<0.01). As a result of logistic regression analysis, a surrogate decision-maker among bereaved family members tended to wish intravenous infusion (OR: 1.62, p=0.02) and continuation of oral medicine (OR: 1.74, p<0.01). The medical professionals who regarded good relationships with people as a requirement of good end-of-life care tended to wish surgery (OR: 2.15, p<0.01) and life-prolonging treatment (OR: 2.00, p=0.01). Conclusions: This result suggest that since the medical preferences between medical staff and the family members don’t necessarily correspond, medical professionals need to take it into consideration when they discuss the treatment options.

Purpose: This study aimed to investigate the current status and related factors of End of Life discussions between heart failure patients and medical professionals. Method: We conducted a survey of medical records of patients who died between April 2015 and March 2020 in the Department of Cardiology, Kyoto University Hospital. We examined the presence or absence of discussions about prognosis and end-of-life care and their associated factors. Result: Of the 109 patients, prognosis was explained to 40 (36.7%) and discussion of end-of-life care was provided to 25 (22.9%). Age (younger), number of hospitalizations, palliative care team intervention, and end-of-life care discussions were associated with the prognostic explanations. Gender (male), number of hospitalizations, history of heart failure hospitalization, palliative care team intervention, and prognosis explanation were associated with the end-of-life care discussions. Conclusion: The study suggested that End of Life discussions in heart failure patients are currently focused on patients with severe and end-stage heart failure.

Purpose: This study aimed to report on the multidisciplinary web conferences for patients with heart failure to strengthen medical collaboration and provide seamless support. Method: We described and analyzed the web conferences by retrospectively collecting data on the conferences. Result: Main subjects of the conferences were those who lived alone and had inadequate nursing care, and those to whom the intervention of multidisciplinary professionals needed to be strengthened to prevent readmission. Using web conferencing tools, we shared issues and solutions for discharge with considering the anonymity of the patient’s personal information. The conferences were held once weekly for 30 minutes when the patients were in the stages of preliminary discharge planning. Participating physicians and healthcare professionals included cardiologists, nurses, pharmacists, physical therapists, nutritionists, palliative care physicians, and home doctors. The cardiology staff used a multifaceted checklist to clarify issues while sharing the patient’s condition and treatment plan. The palliative care physicians made suggestions about value-based treatment plans and decision support, and the home doctor made suggestions about home services, drug adjustment, and lifestyle guidance necessary to prevent readmission. Discussion: Further improvement in the web conferences and evaluation on the effect of the conferences are needed.