Purpose: The purpose of this study was to examine the reliability and validity of the behavioral intention scale for end-of-life discussions. Methods: The scale items were developed according to the Theory of Planned Behavior. The drafts of the scale were created by Item-Level Content Validity Index (I-CVI) and a preliminary test. In the main study, we administered a cross-sectional questionnaire on the web to the participants 20–79 years of age (n=860), living in Tokyo and six surrounding prefectures, and a retest one week later (n=665). We examined item analysis, calculation of a reliability coefficient (intraclass correlation coefficient, Cronbach's alpha coefficient), construct validity, and concurrent validity of the scale. Results: Six factors identified by an exploratory factor analysis were; outcome evaluation, perceived power, control beliefs, motivation to comply, normative beliefs, and behavioral beliefs. The alpha coefficient of the overall scale was .96. The effect size that was determined based on known-groups validity and the correlation coefficient determined on the basis of concurrent validity were moderate. Conclusions: The reliability and validity of the scale were generally confirmed.

Background: Factors requiring midazolam in addition to systemic opioids to control dyspnea in cancer patients have yet to be evaluated. Methods: We retrospectively analyzed data for cancer patients who received systemic opioids to relieve dyspnea from April 2019 to July 2021 in Wakayama Medical University Hospital, Japan. Patients were divided into an opioid-alone group and an opioid plus midazolam group, according to the treatment of dyspnea. Results: The total of 107 patients included 85 patients (79.4%) in the opioid alone group and 22 patients (20.6%) in the opioid plus midazolam group. Age<60 years (p=0.004) and male sex (p=0.034) was significantly associated with the addition of midazolam. Multivariate analysis found age <60 years (OR=5.34, 95%CI: 1.66–17.21; p=0.005) was associated with the addition of midazolam. Conclusion: Age <60 years is factor requiring midazolam in addition to systemic opioids to control dyspnea in cancer patients.

Supporting patients’ decision making of whether to continue chemotherapy as the disease stage progresses poses a significant challenge in cancer nursing. This study aimed to investigate outpatient chemotherapy unit nurses’ perspectives on reconsidering treatment continuation, and their subsequent actions. In total, 14 nurses participated in focus group interviews, and the interview content was analyzed using content analysis methods. The nurses’ perspectives on determining when to reconsider treatment continuation were grouped into four categories, including “respecting the patient’s desired way of life,” and “maintaining the patient’s quality of life and ability to lead their daily life as desired.” Additionally, three categories of subsequent actions were identified, such as “engaging in discussions with patients to plan future treatment aligned with their desired way of life” and “facilitating cooperation among nurses to ensure timely intervention for treatment discontinuation.” The outpatient chemotherapy unit nurses provided daily nursing care from a clinical ethics perspective, focusing on respecting patients’ desired ways of life. They also valued collaborative efforts among medical staff to enable timely interventions.

Purpose: To examine the feasibility of the Integrated Palliative care Outcome Scale (IPOS), a comprehensive palliative care scale, for non-cancer patients. Methods: Twenty non-cancer patients and 20 healthcare providers who provide care to the participating patients were asked to complete the IPOS questionnaire, and cognitive interviews were conducted with them. The interviews were analysed using content analysis, a qualitative analysis method. Results: About half to 90% of both patients and healthcare providers answered that they did not find it difficult to answer or understand all items of the IPOS. Therefore, we confirmed its surface validity, and the content validity of the IPOS was confirmed. Conclusion: The surface validity and content validity of the IPOS for non-cancer patients were confirmed, and it became clear that the IPOS can be used as a comprehensive assessment tool for the palliative care of non-cancer patients.

Introduction: We experienced a case in which an epidural block was useful in estimating the cause of low back pain in a patient suffering from esophageal cancer with liver and paraaortic lymph node metastases. Case: A 69-year-old male with a history of surgery for lumbar disc herniation (at the age of 20). He was diagnosed with esophageal cancer and during follow-up, he noticed low back pain, followed by epigastric pain. MRI revealed L1/2 and L2/3 intervertebral disc herniation. The thoracic epidural block was performed from Th8/9 under X-ray fluoroscopy to alleviate symptoms and identify the cause of low back pain. After confirming the analgesic effect, we conducted a splanchnic nerve block using neurolytic agent (anhydrous ethanol), resulting in total pain elimination. Subsequently, the patient passed away under good pain control without increasing the dose of analgesics. Conclusion: By confirming the effectiveness of epidural block at the thoracic level in advance, the complicated pain was thought to be derived from not lumber disc herniation, but the visceral nerves. An epidural block was useful for the selection of subsequent analgesic therapy.

The purpose of this study was to understand the needs and experiences of children and their families after the illness and bereavement of a terminally ill parent, and the support provided by nurses and multidisciplinary cooperation, from the domestic literature, and to clarify issues related to nursing care to be addressed in clinical practice in the future. We searched the available literature as of November 2022 using Igaku Chuo Zasshi web version. The results were classified into six categories: needs before bereavement of spouse and children, life experiences after bereavement of spouse and children, how to inform/explain to children about the illness and death of terminally ill parents, involvement of nurses for children with terminally ill parents, nursing intervention for children caring for terminally ill parents, and collaboration with multiple professions. The results were categorized into the following six categories. The results suggest the need to recognize children as members of the family and to explain their medical conditions according to their age and developmental stage. In addition, collaboration with schools and other outside organizations was important for continued support of the children. In addition, nurses need to gain experience and learning, and develop a specific system for children and their families.

Objective: To evaluate the efficacy of high-flow nasal cannula oxygen (HFNC) for dyspnea in patients with advanced disease. Methods: A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Ichu-shi Web. Inclusion criteria were: 1) randomized controlled trials evaluating the effect of HFNC on dyspnea; 2) aged 18 years or older with advanced disease with hypoxemia; 3) control group was conventional oxygen therapy or noninvasive positive pressure ventilation. Exclusion criteria were: 1) patients in intensive care unit, 2) weaning from ventilator. Results: Six studies (4 from database searches, and 2 from hand searches) were included. In the 2 studies evaluating short-term intervention, one showed HFNC was more efficacious, and the other conventional oxygen was more efficacious. In the 2 studies evaluating long-term interventions: one showed HFNC was more efficacious, and the other showed no significant difference. In the 2 studies evaluating the intervention during exercise, one showed HFNC was more efficacious, and the other showed no significant difference. Conclusion: HFNC may be effective for dyspnea in patients with advanced disease associated with hypoxemia.

Palliative radiotherapy, when properly administered, contributes to improving the quality of life of patients. Although the usefulness of radiotherapy has been increasingly recognized, the need for palliative radiotherapy from home healthcare institutions has not yet been met. Although there are patients undergoing home care who would benefit from radiotherapy to improve their quality of life, it is difficult to determine the indication in the home care setting, where diagnostic imaging tests are not readily available. In addition, patients undergoing treatment at home often have a lowered performance status, making frequent visits to the hospital difficult and limiting their means of transportation. Under these circumstances, we have been providing palliative radiotherapy in cooperation with home care clinics.

The purpose of this study was to clarify the changes in the sense of difficulty hospital staff felt toward palliative care before and after a palliative care team of the pediatric hospital started in-hospital consultation. A self-administered questionnaire about the difficulty, consisting of 21 items in five areas, was used to conduct a survey in 2015 for the pre-consultation period, and in 2018 for the post-consultation period. Responses were obtained from 222 people in the pre-consultation period (response rate of 70.9%) and from 384 people in the post-consultation period (response rate of 87.3%). Over 70% of the respondents were nurses and midwives. A lower sense of difficulty was observed in three of the items including “relief of painful symptoms”, “family care during caregiving”, and “support when oneself and surrounding staff feeling inadequate and lost”. Further, a significant decrease was observed in the sense of difficulty in six items reported by nurses and midwives in departments receiving the interventions. Eleven of the 16 cases in which the palliative care team intervened involved multiple requests for intervention for 2 patients with pain control difficulties, suggesting that the consultation activities contributed to the decrease in the sense of difficulty experienced by nurses and midwives.

In 2018, the OK Project was launched with the aim of sharing with children the essence of spiritual care fostered in hospice and palliative care. The project developed teaching materials, trained certified instructors, and delivered classes. By September 2023, 189 instructors were certified and a total of 720 programs delivered (202 in elementary schools, 88 in junior high schools, 25 in high schools, 78 in universities and vocational schools, and 327 in other schools) with 53,360 participants. Comments from the participants after the classes (freely written) indicated that they found support from their painful experiences, felt relieved after listening to the stories, wanted to be supportive themselves, and wanted to share what they had learned with others. As a follow-up for certified instructors, a place for certified instructors to learn from each other was regularly held online, and an environment was created where they could practice their presentations and provide feedback. OK Project has a potential to contributing to Compassionate Community because children can live in peace while embracing suffering that is difficult to resolve.

To limit the spread of coronavirus disease 2019 (COVID-19), restrictions on visitation were implemented in palliative care units (PCUs) during the pandemic, requiring inpatients and their families to be separated. In July 2023, Saiseikai Utsunomiya Hospital lifted the restrictions on visiting in the PCU after implementing thorough infection control measures. During the study period (May 8, 2023 to September 17, 2023), 80 patients were admitted to the PCU, no COVID-19 cases were reported, and no visitors reported becoming infected after visitation. The average number of visitors per day during the first 2 months after restrictions were lifted was 23, with a median stay of 83 minutes per visit. The percentage of visitors who were relatives of inpatients was 89% after restrictions were lifted. The average bed utilization rate was 45% during the 2 months before the decision to lift the restrictions, and was 76% during the 2 months after restrictions were lifted, recovering to the pre-pandemic level. These results demonstrate that visiting restrictions in PCUs can be lifted without increasing the incidence of COVID-19 if thorough infection control measures are taken.