The effects of a fan to reduce dyspnea have been evaluated in several trials worldwide, however, there has been no clinical report in terminal cancer patients in Japan. We conducted a retrospective chart review to examine whether a fan is useful for dyspnea in terminally ill cancer patients. We reviewed medical and nursing records and selected all patients（n＝9）who received a fan from July 2013 and January 2014. The primary outcome measure was a decrease dyspnea measured by a visual analogue scale（VAS；0＝no shortness of breath, 100＝worst shortness of breath）. There was a significant difference in the VAS score after treatment with the fan（40.2±11.8 versus 15.6±14.9, P＝0.004）. Our results suggest that a fan may help in reduces the sensation of dyspnea in patients with terminal cancer. Future prospective study is needed.

Long-term care facilities have important roles providing end-of-life-care in Japan. The purpose of this literature review was to examine the current research trend regarding quality evaluation and improvement for end-of-life-care in Japanese long-term care facilities. From a search of key medical databases, potential articles regarding end of life at long-term care facilities were retrieved. We classified retrieved 23 literatures into four research types; four intervention studies, three surveys for development educational / quality improvement tool, thirteen cross-sectional surveys, three qualitative studies. Despite the current increment of the literatures, intervention studies were a few. Related factors of the death in the facilities included administrators’ policy regarding end of life care, and collaboration with the medical institutions, and clear family decision making regarding end of life care. Some research indicated that staffs in long-term care facilities felt difficulty in collaborating with medical institutions, conducting interdisciplinary work, and confirming residents’ intention regarding end-of-life. The results indicate that conducting quality intervention study, supporting administrators of long-term care facilities, promoting residents and family decision making and education for the staffs in long-term care facilities might be effective to improve quality of end-of-life care in long-term care facilities.

Objectives:To determine the factors that influence the decision maker regarding end-of-life (EOL) care and to disclose how aggressive care in the last week before death, place of death, and quality-of-life (QOL) affected the decisions made. Methods:The subjects were 409 bereaved family members (cause of death included cancer, stroke, heart disease, and pneumonia) that registered with an internet research agency. Decision-making was controlled either by the patient, family, or physician or shared by the patient, family, and physician. Results:The results of a multinomial logistic regression analysis demonstrated that when a family controlled decision-making, they were less likely to report patient-family EOL discussion [odds ratio (OR)=0.52], and that the patient had good communication with the physician (OR=0.77); they were also likely to report that the patient had dementia (OR=1.94). Families who reported physician-controlled decision-making (vs patient controlled) were less likely to report that the patient had good communication with the physician (OR=0.62). Cardiopulmonary resuscitation in the last week and place of death were not associated with the decision maker. EOL QOL was associated with EOL care of the decision maker. When a physician controlled decision-making, patient EOL QOL was at its lowest. Conclusion:To improve patient-controlled decision-making, it is critical that patients, families, and physicians have more communication regarding EOL care.

Objectives: This study aimed to evaluate the consequences of caring for end-of-life elderly patients from the bereaved family’s perspective. Methods: We conducted a cross-sectional, anonymous, self-report questionnaire survey for bereaved family members by web survey. Outcomes were caregiving consequences (Caregiving Consequences Inventory). We compared the outcomes between with and without dementia. Results: 163 and 224 dying elderly patients with and without comorbid dementia were analyzed from bereaved family members’ responses. The outcomes were not significantly different (burden, 5.24±1.12, 5.32±1.24, p=0.487; fulfillment, 4.53±1.06, 4.59±1.29, p=0.627; growth, 4.94±0.93, 5.00±1.04, p=0.523). Fulfillment was significantly associated with spouse, family visitation, and mental health. Growth was significantly associated with age, spouse, end-of-life discussion, and family preference of treatments. Conclusion: The evaluation of the consequences of caring for end-of-life elderly patients from the bereaved family’s perspective were not significantly between the informal caregivers of those with and without comorbid dementia.

Objectives: This study aimed to evaluate good death (end-of-life quality of life) from the perspective of bereaved family members. Methods: We conducted a cross-sectional, anonymous, self-report questionnaire survey for bereaved family members by web survey. Outcomes were achievement of a good death (Good Death Inventory, GDI). We compared the outcomes between with and without dementia. Results: 163 and 224 dying elderly patients with and without comorbid dementia were analyzed from bereaved family members’ responses. The achievement of good death were significantly different (GDI scores, 4.2±1.0, 4.4±0.9, Adj P=0.053) as regards “maintaining hope and pleasure,” “good relationship with family,” and “independence.” Conclusion: The achievement of good death was not significantly different between the dying elderly patients with and without comorbid dementia. Psychosocial care for informal caregivers would be important for better quality of dying in the terminally ill elderly patients with dementia.

Aim: To clarify the predictive risk factors for bedsores of terminal cancer patients receiving home-based care. Methods: A retrospective study was conducted involving 95 terminal cancer patients receiving home-based care, including people using services provided by home-visit care providers until death. Results: The numbers of patients with and without bedsores were 31 and 64, respectively. Bivariate analyses revealed that significant variables were the Ohura-Hotta scale (P=0.02), hyperactive delirium (P=0.005), contracture (P=0.008), and anemia (P=0.02). According to multivariable logistic analysis, significant variables were contracture (OR=16.55, P=0.0002) and hyperactive delirium (OR=4.22, P=0.008) as independent risk factors for bedsores. Discussion: For terminal cancer patients receiving home-based care, hyperactive delirium should also be considered as a predictive risk factor for bedsores.

Purpose: To clarify factors associated with the Japanese perception of whether they can live at home until death with the inclusion of knowledge and beliefs about end-of-life. Methods: A questionnaire survey was conducted on the Japanese general population who participated in a lecture meeting about palliative home care (N=61, effective response rate, 100%). Results: Ten (16%) responded they could live at home until death. Barriers to end-of-life home care were "Home care would burden my family (80%)," " Family and I are anxious about emergency care when I get worse (59%)" and "Family and I are anxious about whether I can enter a hospital emergently when I get worse (52%)" in that order. From the multivariate logistic regression model, respondents who expressed "Opioids cause addiction (OR, 95% confidential interval (CI):0.29, 0.09-0.99)" and "Artificial hydration and nutrition should be continued as the minimum standard until death (OR, 95%CI:0.39, 0.16-0.95)" were more likely to perceive that they could live at home until death. Conclusion: The empowerment activity for the general population regarding correct knowledge about palliative care, benefit and disadvantage of life-sustaining treatment, and correct knowledge about home care is important for the end-of-life patients who want to live at home until death to achieve their wish.

As measuring the quality of palliative care is considered to be important, quality indicators (QIs) that are able to extracted from medical database or from medical chart review have recently been developed in Western countries. In this paper, we reviewed the development of QIs and actual measurements collected in palliative care settings. The present results indicate that QIs based on data extracted from such sources as the cancer registry, medical claim, and palliative care databases, include items regarding aggressive treatment, hospice use, and intensive care units visits. Furthermore, QIs based on data extracted from medical chart reviews were developed for use with community-dwelling elderly patients. As with other QIs, QIs utilized at ICUs, QIs utilized at nursing homes, and evaluation of care from the perspective of bereaved families was conducted. In the future, QI items and methods appropriate for Japanese medical settings should be developed and their feasibility, reliability, and validity should be examined.

The aim of this study was to explore the changes in the rates of discharge to home from the palliative care unit in the region where the regional palliative care intervention program, their home death rate, and their ratio to whole home death cancer patients in the region. During the study period, the palliative care unit changed an administrative policy actively end-of-life care to support patients at home. The rate of discharge to home from the palliative care unit increased 11% to 22% during the study period, and their home death rate increased 10% to 41%. The overall home death rate of cancer patients however remained 6.8% to 8.1%, and their ratio to whole home death cancer patients in the region was less than 10%. To establish health care system to support cancer patients at home, changing administrative policy of palliative care units is insufficient and increasing quality community palliative care resources seems to be essential.

Objectives: The aim of this study is to explore prevalence and determinants of complicated grief, depressive symptoms, and suicide ideation among the relatives whose family members died in palliative care units. Methods: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the Center for Epidemiologic Study Depression Scale (CES-D), Inventory of Traumatic Grief (ITG), the item concerning suicide ideation, Care Evaluation Scale (CES), and Good Death Inventory (GDI). Results: Of the 653 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 67%). The results showed 10 (2.3%) respondents with complicated grief and 153 (43.8%) with depressive symptoms. Suicide ideation was appeared among 52 (11.9%) respondents. Multiple regression analysis revealed that ITG was signicicantly associated with both CES and GDI. Patiens' age at death and pre-bereavement health contributed to the suicide ideation of the bereaved family members. Conclusion: The prevalence of complicated grief and depressive symptoms among the relatives whose family members died in palliative care units were 2.3% and 43.8%, respectively. The rates of suicide ideation was 11.9% of respondents. The results suggested that the evaluations about structure and process of palliative care, and quality of death contribute to better adjustment of the bereaved.