Purpose: Palliative care is an essential part of integrated cancer treatment. This study aimed to identify general practitioner (GPs)' perceptions of palliative care and the difficulties they encounter in providing care to terminally ill cancer patients. Methods: Japanese GPs in a rural area where palliative care resources were inadequate were surveyed by questionnaire. Using the questionnaire, researchers visited 62 clinics in the area and carried out semi-structured interviews to identify problems and to investigate possible ways to promote the provision of palliative care by GPs. The transcripts were manually coded into descriptive and interpretive categories. Results: Seventy seven out of 95 responded to the questionnaire (effective response rate: 81%). Experience of pain control was inversely related to the extent of the GPs' perceived difficulties in providing palliative care. Lack of hospital support and understanding of patients and their families were also barriers to the provision by the GPs of palliative care to terminally ill cancer patients at home. The suggested solutions were: to provide seminars for doctors in the area to improve their pain control and other clinical skills; to build up good relations between the doctors in hospitals and clinics in the area; and to educate patients, families and the community at large in the necessity of palliative care. Conclusion: Our study indicated that building up good inter-organizational relations among physicians and educating the community were important in order to promote GPs' participation in palliative care. Palliat Care Res 2009; 4(2): 112-122

This study aimed to explore participant experiences and perspectives of a multidisciplinary conference held after a cancer patient's death in the home setting under planning by the regional palliative care team. The multidisciplinary conferences studied were held in the community following the deaths of three cancer patients who were cared for at home or in nursing homes and supported by a regional palliative care team. We surveyed a total of 56 participants across the three conferences using a questionnaire comprising demographical questions and free description. We asked for impressions of the conference and perspectives regarding palliative care. The survey drew 48 effective responses (response rate, 87.5%). Content analysis of the participants' descriptions extracted the following issues with the multidisciplinary conferences, categorized under either as availability or problems: “mutual understanding through dialogue between multidisciplinary members”, “awareness leading to future practice”, “learning about palliative care”, and “barrier to dialogue between multidisciplinary members”. Highlighted problems surrounding the practice of palliative care with multi-institutional and multidisciplinary members were “conditions for practice in palliative care and care for dying patients” and “multi-institutional and multidisciplinary coordination”. The results indicated that multidisciplinary conferences held with the regional palliative care specialists following a cancer patient's death might be useful to facilitate multidisciplinary coordination and lead to better practice in palliative care in the community.

OBJECTIVES: There is no systematic review on economic evaluations of telemedicine in Japan, despite over 1000 trials implemented. Our systematic review aims to examine whether Japan's telemedicine is cost-saving or cost-effective, examine the methodological rigorousness of the economic evaluations, and discuss future studies needed to improve telemedicine's financial sustainability. METHODS: We searched five databases, including two Japanese databases, to find peer-reviewed articles published between January 1, 2000 and December 31, 2014 in English and Japanese that performed economic evaluations of Japan's telemedicine programs. The methodological rigorousness of the economic analyses was assessed with a well-established checklist. We calculated the benefit-to-cost ratio (BCR) when a reviewed study reported related data but did not report the BCR. All cost values were adjusted to 2014 US dollars. RESULTS: Among the 17 articles identified, six studies reported on settings connecting physicians for specialist consultations, and eleven studies on settings connecting healthcare providers and patients at home. There are three cost-benefit analyses and three cost-minimization analyses. The remaining studies measured the benefit of telemedicine only, using medical expenditure saved or users' willingness-to-pay. There was substantial diversity in the methodological rigorousness. Studies on teledermatology and teleradiology indicated a favorable level of economic efficiency. Studies on telehomecare gave mixed results. One cost-benefit analysis on telehomecare indicated a low economic efficiency, partly due to public subsidy rules, e.g., a too short budget period. CONCLUSIONS: Overall, telemedicine programs in Japan were indicated to have a favorable level of economic efficiency. However, the scarcity of the economic literature indicates the need for further rigorous economic evaluation studies.
Asian Continental Ancestry Group ; Budgets ; Checklist ; Cost-Benefit Analysis* ; Costs and Cost Analysis ; Health Expenditures ; Health Personnel ; Humans ; Japan* ; Referral and Consultation ; Specialization ; Telemedicine* ; Teleradiology

An amendment to this paper has been published and can be accessed via the original article.

BACKGROUND: The living arrangement has been suggested as an important factor affecting health. Recent studies have also suggested that there was a risk among elderly persons who were not alone. This study examined whether the detailed living arrangement was associated with a future decline in functional capacity in the elderly, by gender, in a Japanese suburban city. METHODS: A 3-year longitudinal questionnaire survey (baseline: 2011; follow-up: 2014) for aged 65 years or older was conducted in Kurihara city, Japan. Of the respondents in the baseline survey, we analyzed those who scored 13 points (a perfect score which indicates the highest functional capacity; n = 2627) on the Tokyo Metropolitan Institute of Gerontology Index of Competence at the baseline. The exposure was living arrangement at baseline, divided into five categories: "with spouse only," "living alone," "with child and his/her spouse," "with child without his/her spouse," and "with other family/person." The outcome was the decline in functional capacity at the follow-up survey (score decreased to 10 points or less from 13 points). RESULTS: Of the 2627 analyzed population, 1199 (45.6%) were men. The incidence of the decline was 5.8% in men and 5.9% in women. Multivariable logistic regression analyses adjusted for age, educational attainment, and health behavior and condition revealed that in women, the odds ratio of the decline was higher in living with child and his/her spouse (2.41, 95% confidence interval; 1.10-5.28) referring to living with spouse only. When adjusting activities inside and outside the home such as housework additionally, the association was attenuated to marginal significance (2.25, 0.98-5.18). No statistical significance was observed in men. CONCLUSIONS These results suggested that living with child and spouse of a child was associated with the future decline in women's functional capacity.
Activities of Daily Living ; Aged ; Aged, 80 and over ; Female ; Geriatric Assessment ; Humans ; Independent Living ; statistics & numerical data ; Japan ; Longitudinal Studies ; Male ; Self Report