The principal aim of the present study was to clarify what kind of assessments are performed by nurses practicing delirium care for terminal cancer patients. We conducted semi-structured interviews twice with six certified nurse specialists in cancer nursing/certified nurses in palliative care. Furthermore we analyzed the results using qualitative content analysis techniques. Our results revealed that nurses performed risk assessments to prevent delirium based on “understanding risk of developing delirium based on both intuition and knowledge,” performed assessments based on “examination of information necessary for early detection based on the risk of onset of delirium” and “determination of whether emerging symptoms are delirium” to determine the presence of delirium, and understood the aspects of delirium and experiences of delirium patients through “exploring factors already appearing in delirium,” “understanding the overall picture of delirium performed after determination of delirium,” and “significance of symptom experience of delirium.” These findings suggest how educational intervention should follow the stages of this assessment in order to improve the quality of delirium care for terminal cancer patients.

Purpose: The aim of this study was to develop a nursing intervention program for use in enhancing the self-care abilities of cancer patients receiving treatment on an outpatient basis. Method: Four-week-long combined group therapies were conducted on 15 subjects. The effects of these therapies were then examined. Results: Subjects' mean age was 56.86±11.52 years; mean duration of disease was 28.6±18.14 months. Between before and after the intervention, two scales showed significant improvements: EORTC QLQ-C30 Global health status (p<0.023) and STAI state anxiety scale (p<0.022). As a result of field note data analysis, "change of attitude toward cancer treatment at home" and "response to the program" were identified. Conclusion: Because the subjects were highly motivated individuals, with substantial self-care ability from the beginning, their ESCA scores did not show any change between before and after intervention. Nevertheless, the inner changes that occurred to the subjects indicated that their self-care ability had improved. Palliat Care Res 2009; 4(1): 201-206

This study aimed to describe the conflicts experienced by the nurses who provide end-of-life care in emergency departments. We performed semi-structured interviews for 11 nurses and analyzed the data using content analysis. The conflicts experienced by nurses who provide end-of-life care in emergency departments caused by the “mixed lifesaving and end-of-life care,” “difficulty to catch of the needs of a patient and the family,” and “uncertainly of the goal of nursing care.” “Conflicts of the environment of end-of-life care,” “conflicts of an ethical principle,” “conflicts of the relationship with the family and medical team,” and “conflicts of nursing care to practice without assurance” indicated that the nurses were unable to perform their roles. “Conflicts of the view of life and death as a nurse” contributed to the psychological burden of the nurses. These findings suggest that nurses’ roles to the special requirements of the emergency department should be examined. Further, the goal of nursing care should be sufficiently examined and developed in agreement with the patients’ families and medical teams, based on the existing procedures. In addition, the psychological support of the opportunity of debriefing is important for these nurses.

Purpose: To understand the experiences of and difficulties faced by palliative care unit nurses when caring for refractory cachexia. Method: Palliative care nurses completed anonymous self-report postal questionnaires. Factor and multiple regression analyses were then carried out to interpret results. Results: A total of, 169 valid questionnaire responses were received and analyzed. Six factors were identified relating to the difficulties experienced by nurses when caring for refractory cachexia. [A feeling of helplessness and conflict among patients and families faced with decline and death] was considered the most difficult factor experienced by nurses, and typically other difficulties were considered more prominent when this factor was present. [The approach of assessment and perception of refractory cachexia care] differed according to the nurse’s years of experience, degree of involvement in patient care, and learning opportunities previously encountered. [Nurses tended to cope] more easily with the challenges faced if they had been assigned for >3 years. Conclusion: Six factors were identified as difficulties associated with the care of refractory cachexia. These findings suggest the need for thoughtful dialog with patients and their families and the importance of further educational support for nurses.

Purpose: To elucidate the actual state of difficulties and related factors of nurses in caring for patients with recurrent and metastatic malignant musculoskeletal tumor. Methods: The subjects were 315 nurses from 12 institutions that treat malignant musculoskeletal tumor. We researched the difficulties of nurses regarding cancer nursing and care of patients with malignant musculoskeletal tumor. We examined the related factors by multiple regression analysis. Result: 165 nurses responded (effective response rate 52.4%). Among “Nurses’ difficulty with cancer care”, the level of difficulty regarding communication was the highest and in own knowledge/technology, system/regional cooperation was also high. Among “Nurses’ difficulty with care for patients with malignant musculoskeletal tumor”, there was a high degree of difficulties regarding the target characteristics of care. Related factors were facility characteristics, nursing experience, nursing experience of musculoskeletal tumor, learning methods for musculoskeletal tumor nursing, and multi-professional conferences. Conclusion: Nurses caring for patients with malignant musculoskeletal tumor have specific difficulty due to total pain, age of onset, and rarity. Educational support based on related factors is therefore required.

Objective: This study aimed to investigate self-perceived burden (SPB) on families experienced by patients with cancer undergoing outpatient chemotherapy, and factors that affect SPB. Methods: Self-administered questionnaires were sent to patients with cancer in 17 designated cancer care hospitals. Of 1,981 effective responses (response rate 54.7%), 600 patients with cancer undergoing outpatient chemotherapy were included in this study. Results: More than 85% of participants reported SPB on their families. Multiple logistic regression analyses revealed independent physical and social factors that influenced the SPB on families among patients with cancer undergoing outpatient chemotherapy. Physical factor was recurrent or metastasized. Social factors were 40s or younger; living with families; marital history; worries of work or financial problems; worries of interpersonal relationship with families and others. Discussion and Implications: Our findings suggest that medical staff may need to offer psychological care according to patient’s cancer progression and support according to their social background to reduce SPB on their families.

Objective: This study aimed to investigate Japanese cancer patients’ perceptions of the scope of palliative care and factors that affect those perceptions. Methods: An anonymous, self-administered questionnaire was distributed to hospitalized patients and outpatients in designated cancer care hospitals in Japan. Data were first summarized using descriptive statistics. Then, using a χ² test followed by multiple logistic regression analysis, we compared patients who recognized palliative care as terminal care with those who viewed it as care that is relevant earlier in the disease course. Results: Of 3,622 questionnaires, 1,981 were completed (response rate: 54.7%). A total of 1,187 (59.9%) respondents perceived palliative care as care that could be implemented early in the disease course, whereas 414 (20.9%) respondents perceived palliative care as only relevant for the end-of-life stage. Respondents who had received palliative care for symptoms were significantly less likely to recognize it as terminal palliative care only than those who perceived that they were not the subject in the scope of care for symptoms. A diagnosis of advanced cancer and being under 40 years old were factors significantly related to the perception of palliative care as terminal only. Discussion and Implications: Our findings suggest that health care providers should be conscious of the possibility that palliative care practices affect patients’ perceptions of palliative care. Providing information about palliative care before occurring painful symptoms can help promote patients’ access to and understanding of it.

Objectives: This study aimed to explore nurses’ treatment preferences for patients with advanced cancer and investigate the factors affecting these preferences. Methods: Self-administered questionnaires were distributed to nurses at two hospitals who had experience in cancer patient care. Nurses recorded their treatment preferences and nurses’ value considered in their preferences for two vignettes of patients with advanced cancer that differed in performance status (PS) and prognosis. Univariate and multivariate analyses were used in this study. Results: Of 383 nurses, 300 (valid response rate, 78.3%) responded. Multiple regression analyses revealed that regardless of patients’ prognosis or PS, nurses’ treatment preferences were associated with their values regarding respecting patient wishes and the low probability of prolonging survival through treatment. For case with one month survival prognoses, nurses valued avoidance of discomfort, associated with side effects through treatment. Nurses recommended treatment in case with prognoses of 6 months and PS of 1, while they responded with almost same percentages of recommendation of continuing and discontinuing treatment for those with prognoses of 1 month and PS of 3. Conclusions: Nurses’ treatment preferences were associated with nurses’ values. Nurses’ involvement in treatment decision-making processes after sharing goals for patients’ treatment is potentially beneficial.

Objective: To identify effective strategies to provide high-quality palliative care in settings where palliative care specialists are scarce, particularly in Japan. Methods: A scoping review of literature (in English) was conducted using Arksey and O’Malley’s methodological framework. Electronic databases (MEDLINE, CINAHL, and the Cochrane Library) were searched and supplemented with a manual search of relevant journal articles. Results: Nine studies met our inclusion criteria. Four key strategies have emerged: (1) developing a video consultation system to improve the timeliness of care; (2) providing online consultations by specialists to support general practitioners; (3) training nurses to manage the palliative care process; and (4) transferring knowledge and information from experts to non-specialists. Conclusion: Based on these strategies, creating a system tailored to the specific needs and readiness of palliative care in Japan is necessary. The effectiveness of these strategies should be evaluated in future research.

Objectives: This study aimed to describe the difficulties faced by physicians in providing palliative care to patients with cancer in facilities without palliative care specialists. Methods: Semi-structured interviews were conducted with 11 physicians involved in cancer treatment who were affiliated with facilities having no palliative care specialists such as Diplomate or Board Certification of the Specialty Board of Palliative Medicine of the Japanese Society for Palliative Medicine. The interview data were analyzed using qualitative content analysis. Results: The participants had “difficulties in palliative care consultation” because they could not consult with specialists or medical staff at their own facility, when immediate response to cancer symptoms was required. This was partly due to “difficulties in regional cooperation”. In addition, the participants had “difficulties in alleviation of symptoms” for highly complex symptoms of patients with cancer. Behind these difficulties, there was “difficulties in foundation of providing palliative care for individual physicians” including limited time available to the participants. Conclusion: These findings show that there is a necessity to establish a continuous external consultation system for specialists to respond to the immediacy of changes in symptoms and highly complex symptoms.