The primary aim of this study was to investigate the reliability and validity of a measurement tool to quantify the quality of communication and cooperation among health care providers in a region. A total of 476 health care professionals were enrolled. For the 25-item scale, the internal consistency was excellent. Factor analyses identified 7 underlying factors, such as easy communication with health care providers in other institutions, understanding the role of other disciplines in the region, and knowing the face, name, and the way of thinking. The total score had weak negative but significant correlations with the cooperation subscale of the Palliative care Difficulties Scale. The total score was also significantly associated with the general evaluation of communication and cooperation in the region, the number of participations in whole-region multidisciplinary conferences, the number of persons to whom the respondent could ask about palliative care in the region, and clinical experience in the region. In conclusion, this scale can measure the quality of communication and cooperation among health care providers in a region with acceptable reliability and validity.

Purpose: This study was conducted to verify the reliability and validity of a scale evaluating the quality of communication and cooperation among medical, nursing, and welfare services in a region. Methods: To apply "a measure to quantify the quality of communication and cooperation among health care providers in a region" (Morita et al, 2013) developed for health care professionals engaged in the care of homebound patients to broader profession and disease categories, the measure was modified to newly establish the 26-item "measure to quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region." In total, 362 health care professionals were enrolled in this study. Results: The internal consistency was excellent. Exploratory factor analyses identified the factor structure as being identical to that of the original scale. The total score had negative but significant correlations with subscales for difficulties in regional cooperation on the Palliative Care Difficulties Scale. The total score was also significantly associated with the general evaluation of communication and cooperation in the region, the number of participations in whole-region multidisciplinary conferences, and the number of persons to whom the respondent could inquire about support. Conclusion: This scale may be useful for describing the extent of global communication and cooperation among medical, nursing, and welfare services in a region.

To explore the concept of “kao-no-mieru kankei (face-to-face relationships)” and effects on community care networks, questionnaire and interview surveys were conducted involving 207 and 5 health care professionals, respectively. The item “face-to-face relationships” were significantly correlated with “I know his/her name, face, and way of thinking” “I understand the principles and current status of the facility” “I know his/her characteristics and how to deal with them”, and “I know what each person does” (p>0.7). An interview survey showed that “face-to-face relationships” consisted of “know the name and face” “know what s/he is like” and “trust in each other”. As effects of “face-to-face relationships” on community care networks, the following items were extracted: “It facilitates easy communication” “It provides me with information on who is responsible for which problem” “It facilitates smooth communication by changing my approach” “It makes me effective at work” “It gives me a sense of intimacy”, and “it gives me the responsibility”. Thus, preliminary findings of the concept and effects of “face-to-face relationships” were obtained.

Insomnia in advanced cancer patients has a highly negative impact on the patients, their families and caregivers. Insomnia is principally managed by pharmacological therapy； however, most advanced cancer patients are unable to receive oral medications. This prospective audit study investigated the efficacy of single—dose subcutaneous administration of flunitrazepam for treating insomnia in patients with advanced cancer. Sleep evaluation was conducted using the St. Mary’s Hospital Sleep Questionnaire. The primary endpoint was the quality of sleep； the secondary endpoints comprised other subscales of total sleep time, sleep latency and adverse effects. We enrolled 30 patients. The average dose of flunitrazepam dose was 0.9(0.1)mg. The good response rate for the quality of sleep was 90％. The total sleep time and sleep latency were 7.5(3.2)h and 31(9.1)min, respectively. Two patients were newly diagnosed with delirium during the study. The mean respiratory rate decreased(15/min before treatment to 14/min after treatment, P＝0.01) without any critical events. Single—dose subcutaneous administration of flunitrazepam may be potentially efficacious and simple in treating insomnia in advanced cancer patients.

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.

Clinical decisions on infectious diseases in terminally-ill cancer patients are often made based on physicians’ and nurses’ personal medical experiences, which may lead to an intra-team conflict. We conducted a qualitative analysis with prospectively gathered, semi-structured interviews in order to identify physicians’ and nurses’ beliefs and perceptions contributing to the variabilities in their attitudes toward patient care and the conflicts during decision-making process. We obtained the following categories with respect to beliefs and perceptions: estimated prognosis; patient’s discomfort due to tests and treatment; agreement to physician’s treatment plan; patient’s and family’s wish for tests and treatment; and patient’s benefits by tests and treatment. The intra-team conflicts resulted from disagreement on patient’s condition, and difficulty understanding mutual intent or opinion among physicians and nurses. Our findings may help improve team-based communication and the quality of care in terminally-ill cancer patients with infectious diseases.

The modified Richmond Agitation-Sedation Scale (RASS) seems to be one of the best monitoring indicators for palliative sedation. We translated the modified RASS into Japanese according to the standard methods of conducting linguistic validation. The modified RASS revised two points from the original RASS for use in palliative care setting: deleted the description about the ventilator, and added some descriptions to clarify the meaning of RASS+1. In addition, we have deleted the description “rubbing sternum” in the procedure for RASS assessment, and then translated the modified RASS into Japanese. The translators and our research team members repeatedly discussed the linguistic validity until we agreed that the translated Japanese version is equivalent to the English one. The use of the Japanese version of the modified RASS to monitor palliative sedation may help to perform appropriate, and safe palliative sedation.

Good Death Scale (GDS) is a provider assessment scale of quality of dying of terminally ill cancer patients, and its reliability and validity has been confirmed. The aim of this study is translating the GDS into Japanese (GDS-J) according to the standard methods of conducting linguistic validation. In the forward translation, there was a disagreement in the translation of “will” into Japanese translation of “will” of GDS question 3 “Has the patient arranged everything according to his/her own will?” We confirmed linguistic validity in the research team and eventually got approval from the original author in writing and decided on GDS-J. Using the GDS-J, a quality assessment scale for palliative care by provider, it will be possible to evaluate the quality of palliative care to be done by themselves and to be expected to be useful for providing higher-quality palliative care.

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.