Purpose: This study aimed to verify the reliability and validity of the Japanese version of the Ethical Decision-making Climate Questionnaire (EDMCQ) for decision making in intensive care units (ICU). Methods: The Japanese version was created by translating the English version of EDMCQ. A survey was conducted by mailing the questionnaires, targeting ICU nurses. The test was retested 14 days later. Results: The test was distributed to 439 ICU nurses. Overall, 204 responses from nurses at 25 facilities were received and analyzed (effective response rate: 46.5%). Cronbach’s α coefficient for the entire scale was 0.91, and the intraclass correlation coefficient was 0.80 (n=101, valid response rate: 23.0%). The indices for model fit in the confirmatory factor analysis were CFI: 0.836, GFI: 0.783, AGFI: 0.741, and RMSEA: 0.071. Conclusion: The Japanese version of the EDMCQ can be considered to be a practical scale for evaluation of ethical climate in Japan.

Purpose: To elucidate the factors associated with self-evaluations of end-of-life care (EOLC) practices for non-cancer patients experienced by nurses in general hospitals. Methods: A questionnaire survey was conducted involving 1161 nurses from general hospitals. Results: Comparing the realities of 648 cancer cases with those of 306 non-cancer cases in terms of end-of-life care practices, it was found that significantly lower EOLC self-evaluation scores (on a 10-point scale), fewer instances of eliciting patients’ intentions or wishes, and fewer team discussions related to EOLC practices were observed in the non-cancer cases. (p<0.001). For each disease, pneumonia and heart disease tended to be lower. Self-evaluation of EOLC practices was consistently associated with eliciting patients’ intentions and wishes (β=0.21 for cancer, β=0.16 for non-cancer), and team discussions (β=0.25 for cancer, β=0.35 for non-cancer) for both cancer and non-cancer cases. Conclusion: General hospital nurses’ self-evaluations of EOLC practices for non-cancer patients were lower compared to those for cancer patients. It is necessary to enhance their skills in eliciting patients’ intentions and wishes and to implement a system of care for team discussion.

Objectives: There are known barriers to advance care planning practices for both health care providers and patients. Since physicians were the main occupations that introduce ACP, the goal of this study was to clarify where the difficulties were felt in the practice of ACP by looking back on the practice of physicians who were working in a designated cancer hospital. Methods: Semi-structured interviews were conducted with 10 physicians who were recommended by the palliative care team as physicians who clinically practice ACP for cancer patients. Interviews were transcribed verbatim, coded, and analyzed using content analysis by Graneheim et al. Results: We finally classified into 6 major categories as follows: Insufficient readiness of patients/Insufficient readiness of medical staff/Discrepancy in communication/Lack of evaluation index of ACP/Dilemma with professional ethics. Conclusion: Patients and health care providers each lacked readiness for ACP, and physicians found it difficult due to the resulting communication discrepancies and lack of colleagues with whom they could collaborate.

Purpose: The purpose of this study was to clarify the current status of Do-Not-Resuscitate discussions (DNRd) with terminally ill cancer patients in Japan and the psychological burden on bereaved families depending on whether or not a DNRd is performed. Method: A multicenter prospective observational study of advanced cancer patients admitted to 23 palliative care units (PCUs) in Japan was conducted, and a questionnaire survey of bereaved families was also conducted after patients died. Result: 1,605 patients were included in the analysis, and 71.4% of patients had a DNRd with doctors before PCU admission, 10.8% at admission, and 11.4% during admission. In contrast, 93.3% of family members had a DNRd with doctors before PCU admission, 48.4% at admission, and 52.1% during admission. Conclusion: Although DNRd was performed between patients and physicians in 72.3% of cases at any point throughout the course of time from before PCU admission to death, there was no evidence of psychological burden such as depression or complicated grief in the bereaved families due to patient participation in DNRd.

Introduction: Epileptic patients have a higher risk of death than healthy individuals. Advance care planning (ACP) is also important for epileptic patients, but is not well recognized. We experienced two cases in which ACP was performed by family and medical staff for epileptic patients with intellectual disability. Case1: The patient was a 29-year-old male. It was important to continue spending his daily life as he currently did. Although his family wanted to provide palliative care at the end of life, there were no decisions about which medical interventions may not work at his end of life. It was decided that the family and medical staff would continue to make shared decision making. Case2: The patient was an 18-year-old female. It was important to continue spending her daily life as she currently did. Her family and medical team decided to provide palliative care at the end of life. Based on the opinions of the family members in both cases, the importance and widespread use of ACP in epileptic patients were obtained. Conclusions: ACP enabled families and medical staff to make shared decisions about what is best for epileptic patients with intellectual disability. ACP for epileptic patients seems to need to be promoted.

Our former independent palliative care center has become a palliative care ward in our new general hospital, and deceased patients continue to be discharged through the building’s main entrance. We compared the impact of this change on the discharge experience of bereaved families. As a result, the number of bereaved families who felt uneasy when their relatives were discharged from the hospital increased from 13% to 23%. On the other hand, the number of bereaved families who had a feeling of uneasiness when encountering the discharge of other deceased patients decreased from 52% to 28%. Although positive feedback was received for discharge using the main entrance, our findings emphasize the need for thorough consideration by medical staff of the manner of discharge in general hospitals. In response to bereaved families’ requests, our hospital has introduced a discharge system that allows families to choose whether to leave through the main entrance or through other entrances, aiming to improve the discharge experience.

Aims: To explore unmet needs and enhanced outpatient care functions of palliative care for patients with cancers, scrutinized records of outpatient visits in acute care and regional designated cancer hospital. Methods: A retrospective study was made for a total of 3136 consecutive visits from electronic records between April 2020–March 2023. Results: There were 630 unscheduled visits (20.1%) with 74.0% of them occurring during working hours; a quarter of unscheduled visits were after-hours. Of the total visits, 347 visits (11.1%) resulted in emergent admissions, and of the unscheduled visits, 305 cases (48.4%) were emergent admissions. Ambulances were called in 196 cases (56.5%) of emergent admissions. Moreover, the reasons for unscheduled visits statistically differed from reasons for non-admission cases (p<0.01). Conclusion: Patients’ illness trajectories and our results revealed that palliative care patients with cancers often experience unexpected physical and mental changes. To establish more effective outpatient care, we should construct structures to be available 365 days a year for palliative care patients and to instruct patients and their care givers in advance about warning signs for admission and how to access medical services.