Purpose: To evaluate the usefulness of asenapine sublingual tablets for the treatment of delirium in patients with advanced cancer. Methods: We conducted a retrospective study using electronic medical records of patients with advanced cancer who were admitted to our hospital between October 1, 2019 and September 30, 2022 and who received asenapine sublingual tablets as treatment for delirium. The Agitation Distress Scale (ADS) was used to evaluate the degree of improvement of agitation symptoms caused by delirium. Results: Twenty patients were included in the analysis. The mean ADS(range) before treatment was 12 (4–17), and the mean ADS(range) after treatment was 7.9 (0–18), with the p-value <0.001. Conclusion: Asenapine sublingual tablets may be useful as an option for pharmacological treatment of delirium.

Purpose: In today’s medical field, it is an essential quality competency for staff to not only recognize the importance of patient decision-making and the skills to support it, but also implement it. This study aimed to establish a training program on decision support for healthcare professionals and examine its effectiveness. Method: We conducted the training at a medical institution and conducted a questionnaire survey at two points before and after the training. A total of 88 nurses and doctors participated in the survey. Result: We developed a two-hour training on the knowledge and skills needed for decision support. Questionnaire results showed improvements in literacy and efficacy before and after the training. Discussion: It was confirmed that the training led to an in-depth understanding of the participants’ decision support, and increased the sense of efficacy in their daily work, particularly through responding to patients according to patients’ cognitive and physical assessments, and in actively supporting those who have difficulty in making decisions. There were references to the significance of re-learning and the possibility of applying the training to difficult situations in participants comments. In the future, it is necessary to study decision support with reference toco-operation in the medical field where collaboration among multiple professions is indispensable.

Objective: This study examined the relationship between the quality improvement activities in Japanese palliative care units and the bereavement outcomes of patients’ family members. Methods: From a post-bereavement survey (J-HOPE4) conducted in 2018, we sourced the data of 187 facilities. We summarized the quality improvement activities palliative care units performed and explored how these activities are associated with the bereavement outcomes of patients’ family members: overall satisfaction with the care provided, evaluation of the structure and process of care (Care Evaluation Scale: CES), perceived achievement of a good death (Good Death Inventory: GDI), grief (Brief Grief Questionnaire: BGQ), and depression (Patient Health Questionnaire 9: PHQ-9). Results: Facilities that participated in the self-evaluation program provided by Hospice Palliative Care Japan held multidisciplinary conferences more frequently and had more specialties positions attending conferences (all p<0.05) yielded greater overall satisfaction and perceived achievement of a good death. Facilities that provided bereavement care (all p<0.05) resulted in significantly higher overall satisfaction and favorable care evaluations. Grief was significantly lower when facilities made phone calls to bereaved families (p=0.03), and depression was significantly lower when facilities attended the funeral and wake services (p=0.02). Conclusion: Facilities that actively perform quality improvement activities may provide better palliative care and cause less grief and depression among bereaved family members.

Introduction: In patients receiving opioids, relief of cancer pain by palliative radiation therapy or other means can lead to opioid discontinuation and subsequent withdrawal symptoms, such as agitation, insomnia, and diarrhea, due to opioid-related physical dependence. Appropriate steps should be taken to prevent these symptoms. Case: A 72-year-old man underwent surgery for esophageal cancer. He developed low back pain and right lower limb pain, and was diagnosed with sacral and right iliac bone metastases. His pain was resistant to oxycodone (OXC), so he was simultaneously treated with methadone (MDN) and palliative radiotherapy. His pain gradually decreased, and MDN was tapered and switched to OXC, which was in turn discontinued at 20 mg/day at the patient's strong request. After OXC discontinuation, akathisia, anxiety, and diarrhea appeared as withdrawal symptoms. These were treated with immediate-release OXC, transdermal fentanyl, and suvorexant. Discussion: When discontinuing opioids, dose reduction below 10% per week is recommended, de-escalation to the lowest possible dose should be followed by cessation. In case of withdrawal symptoms, immediate-release opioids may be used, and opioid tapering should be attempted in parallel with symptom control.

Mohs paste (MP) is a topical treatment that can help relieve the symptoms of self-destructive skin lesions caused by malignant tumors. Despite the potential benefits of MP in improving the quality of life of patients, its use in home-based care is limited due to various obstacles. In this study, we developed a 1-mm-thick MP gauze sheet, which allowed us to apply the MP treatment at home to a patient with breast cancer. After three weekly treatments, the patient’s main symptoms, including itchiness, odor caused by exudates, and mobility issues, showed improvement. By using MP as a sheet, we overcame the obstacles associated with its use, such as alterations in the physical properties and the risk of damage to healthy skin tissue. Additionally, we reduced the treatment duration and need for trained personnel. Our findings suggest that the MP treatment can effectively control the symptoms of patients in home-based care, consistent with prior research.

Background: In the case of refractory diarrhea that cannot be treated with loperamide only, drugs such as octreotide and serotonin receptor antagonists are generally recommended. We have reported a case of refractory diarrhea associated with carcinoid syndrome in which symptoms improved only with opioid switching, without octreotide. Case: We experienced a case of a 28-year-old female with cervical cancer. She was diagnosed with recurrence after cervical cancer surgery and presented with pain and diarrhea. Her diarrhea did not improve sufficiently after taking loperamide. She was admitted to the palliative care hospital for symptom control due to persistent diarrhea and right lower extremity pain associated with bone metastasis. We diagnosed the cause of her diarrhea as carcinoid syndrome by some laboratory examination. For pain management, we switched opioids from transdermal fentanyl to continuous subcutaneous infusion of morphine. It resulted in pain relief and improvement in the frequency of diarrhea, and she was able to be discharged home. Conclusion: In cases of refractory diarrhea and in patients who need opioids, there is one option to use morphine. If it is effective, it may simply resolve both pain and diarrhea and reduce the use of multiple medications.

We herein report a case of a 76-year-old male patient with chronic obstructive pulmonary disease whose advance care planning (ACP) was facilited by rehabilitation staff by utilizing dialogue in rehabilitation settings, mainly in the context of conditioning and self-management during pulmonary rehabilitation. When a rehabilitation professional is involved in ACP, it is easy to be involved in the so-called ACP in the broad sense. Compared to other professions, rehabilitation professionals have more time being with a patient for dialogue and can discuss the patient's values and future concerns from a life-centered perspective. To promote ACP in the practical settings, rehabilitation professionals, who have the advantage of having more time for dialogue than other professions, need to be involved in ACP by taking advantage of repeated opportunities for dialogue.