End-of-life discussion with patients with advanced cancer is one of the important factors to determine the patient quality of life and their families' grief. The primary aim of this study is to collect Japanese medical oncologists' views toward end-of-life discussion. A context analysis of free comments of the questionnaire survey was conducted. Questionnaires were mailed to 864 medical oncologists, and 490 responses were obtained. A content analysis identified 420 free comments. As barriers of end-of-life discussion for oncologists, three types of barriers were emerged: 1) issues relating to patient and family (e.g., [individuality of the patient and family], [difficulty of acceptance of illness progression]), 2) issues relating to medical professionals (e.g., [a lack of psychological support], [difference in beliefs about end-of-life discussion among medical professionals]), and 3) health care systems (e.g., [a lack of time and human resources], [a lack of education and research]). The findings of this study may be useful to improve mutual understanding of oncologists and palliative care physicians when performing the end-of-life discussion in collaboration.

A physical activity reference value for health promotion, 23 METs-h/week was established by the Ministry of Health, Welfare, and Labour in Japan in 2006. The purpose of this study was to determine the daily step counts (steps/day) that classify adults as meeting the 23 METs-h/week reference value by using objective measurements. Objectively measured physical activity levels of 1837 Japanese adults aged from 23 - 69 yrs from both urban and rural Japanese cohorts were provided. Amount of physical activity and daily step counts were assessed using a triaxial accelerometer (Actimarker EW4800; Panasonic Electric Works). Receiver operating characteristics (ROC) curve analysis determined the optimal daily step counts (steps/day) that discriminated adults who met the reference value from those who did not. Approximately 48 % of Japanese adults met the 23 METs-h/week of physical activity reference value. ROC curve analysis found that 9341 steps/day produced 77.1 % of sensitivity and 79.5 % of specificity in all subject. When the analysis was performed in each cohort, 9980 steps/day and 8640 steps/day were indicated as the optimal daily step counts for them to meet 23 METs-h/week in urban and rural cohort, respectively. These data suggest that Japanese adults are likely to meet 23 METs-h/week of physical activity reference value if they accumulate between 8500 and 10,000 steps/day of daily step counts.

This study was conducted to identify the needs of patients and their families based on surveys involving patients and bereaved families, and describe the process of producing a survey-based leaflet for health care professionals.Questionnaire surveys were conducted on 550 advanced cancer patients and 632 bereaved families in Hamamatsu, and 337 and 432 responses were collected. Opinions and requests regarding cancer treatment and palliative care were analyzed, and 378 meaning units were collapsed into six categories of requests to health professionals: “Share patient and family feelings and support decisions”; “Allow the patient to stay where he/she wants”; “Relieve physical discomfort as much as possible”; “Support to complete what family members want for the patient not to regret”; “Help patient and family have hope”, and; “Reduce concerns about opioids”. A leaflet for health care professionals about what they should take into the considerations was created based on patient and family surveys.

Ceftriaxone is one of the easily administrative antibiotics, but little is known about their role in palliative care settings. The aim of this study is to show the effect and the safety of ceftriaxone subcutaneous infusion to infection among advanced cancer patients. Consecutive patients who received ceftriaxone subcutaneous infusion at the Seirei Hospice from January 2013 to January 2014 were enrolled in this retrospective analyses. Primary outcome was the response rate of ceftriaxone, determined by improvement of symptoms within 3 days of ceftriaxone use. Secondary outcomes are inflammatory site reaction, and a comparison of the response rate between ceftriatone and other antibiotics. Among a total of 100 admitted patients, 10 patients used ceftriaxone subcutaneous infusion (4 for urinary tract infection, 4 for pneumonia, 2 for soft tissue infection). The response rate was 70% (95% confidence interval, 39－89). There was no inflammatory symptom at the insertion site observed. For comparisons, 16 patients used other antibiotics with the response rate of 74% (51－88).In conclusion, subcutaneous infusion of ceftriaxone can be useful in the treatment of infections of end－of－life cancer patients, and randomized controlled trial is promising.

Understanding the symptoms of the general population has an important role in assessing and improving the quality of palliative care systems. However, there are no reliable epidemiological data on the symptoms of the general population in Japan. The aim of this study was to survey the actual status of the symptoms experienced by the general population in Japan. A large nationwide postal survey was conducted from January through February 2013 in Japan. A total of 2400 subjects were selected randomly from among members of the general population who were 20 to 79 years of age and lived in Japan. The Memorial Symptom Assessment Scale (MSAS) was used to multi-dimensionally evaluate symptoms experienced within the past week, and the Short Form 8™ (SF-8™) was used to assess the health-related quality of life (QOL). A total of 978 (41.1%) self-completed questionnaires were analyzed. The prevalences, severity rates, and distress rates of 35 physical and psychological symptoms were analyzed according to sex and age group. In addition, the relation between symptom severity and the health-related QOL score was evaluated. From the perspectives of public health and administrative policy, the results of this survey will most likely provide important basic data, with the ultimate goal of establishing a palliative care system in Japan.

All residents aged 65 or over in a rural city (n=5340) were studied with a self−administered questionnaire on psychiatric symptoms, physical health status, medical history, and environmental factors. After the screening, the clinical diagnosis of senile dementia was made by psychiatrists. The overall prevalence was 4.0% among responders staying at home (201/4969). The prevalence increased with age for both males and females and tended to be higher for females than males. The multilogistic analysis of the above variables showed that in the cerebrovascular type, stroke and inactive physical status might be risk factors for both gender groups. For the Alzheimer’s type, age and inactive physical status might be risk factors. For overall dementia, age, stroke, and inactive physical status might be risk factors.
Risk Factors ; Senile dementia ; Cities ; Age, NOS ; Prevalence aspects

The primary aim of this study was to describe how patient-held-records was used in the regional palliative care program (OPTIM-study). The number of patient-held-records disseminated was 1,131 per region per year. A total of 15% and 16% of 706 physicians and 2,236 nurses in the region reported that they used patient-held-records disseminated during the study periods, respectively. In-depth interview identified themes [difficulty in dissemination], potential benefits of patient-held-records ([improved sense-of-control of patients], [improved information sharing among health care professionals]), and barriers ([lack of patient-perceived benefits and patient burden], [necessity that all health care professionals involved should be aware the value of patient-held-records and understand how to use it]). Of 11 hospitals who introduced patient-held-records, only 2 hospitals continued to use it during 3-year study periods. In conclusion, region-wide dissemination of patient-held-records seems to be unfeasible in many regions in Japan.

It is important to collect patients' and their families' opinions to provide good palliative care. This study aims to analyze the contents of free description provided by the survey for cancer patients and bereaved families, which was performed before the intervention of The Outreach Palliative Care Trial of Integrated Regional Model (OPTIM) study. Requests for and good points of cancer treatment and palliative care were collected and classified. 1,493 advanced cancer patients and 1,658 bereaved families in four areas received the questionnaire, and 271 patients and 550 families filled in the free description. Cancer patients and bereaved families had demands for improved communication with medical staff, improved quality of pain relief, financial support of treatment, more educational activities on palliative care, and improved cooperation within and outside hospitals. Palliat Care Res 2011; 6(2): 237-245

The experience at the time of a patient’s death can affect the mental health of bereaved families. Performing death pronouncements is an important skill for end-of-life care. However, almost no educational content regarding death pronouncements is presently included in medical educational programs. We have created a guidebook for “Physician behavior at the time of death pronouncement” based on the results of a questionnaire given to the families of deceased patients that included several items related to this topic. The purpose of this research was to investigate the educational effect of using this guidebook. The guidebook was given to 4th-year medical students attending the Yokohama City University School of Medicine. A survey was then conducted to assess evaluations of self-practice and feelings of difficulty at the time of making death pronouncements both before and after the class. Among the 39 students who provided valid responses, the majority (89.5%) indicated that they had difficulty with the item regarding “the specific method of death pronouncement.” A significant improvement was observed between the responses obtained before and those obtained after the class. We concluded that our guidebook for physician behavior at the time of death pronouncement might be useful for the education of medical students.

To decide the policy to promote palliative care properly, a new questionnaire has been added to Patient’s behavior survey to assess Quality of Life (QOL) of inpatients and outpatients in Japan. The aim of this study was to survey QOL score of general population in Japan by using a questionnaire of patient’s behavior survey. A large nationwide postal survey was conducted from January through February 2013 in Japan. A total of 2400 subjects were selected randomly from among members of the general population who were 20 to 79 years of age and lived in Japan. A total of 978 (41.1%) questionnaires were analyzed, and reference data of QOL score weighted by the national standard value of sex-age group population were calculated. Correlation coefficients were calculated between QOL score and SF-8TM, Patient Health Questionnaire-9 (PHQ-9), Eastern Cooperative Oncology Group Performance Status (ECOG), Memorial Symptom Assessment Scale (MSAS) score. In addition, sociodemographic factors related to QOL score were evaluated. From the perspectives of public health and administrative policy, the results of this survey will provide important basic data to evaluate patient’s behavior survey broadly and continuously with the goal of establishing a palliative care system in Japan.