The goal of palliative care is to soothe or relieve the patients with serious illness of their suffering and to improve the quality of their life. It integrates the physical, psychological, social and spiritual aspects of patient care into a comprehensive whole. Doctors and other medical workers talk with the patients by providing appropriate information and explanations and care should be carried out according to the patients' wishes. The care team should confirm their wishes at every opportunity since the patients' wishes can change with time. The presenters who were actually involved in medical care or nursing care discussed how to solve the problems of palliative care and end-of-life care.
End ; Life ; Palliative Care ; Community ; Doctors

The mortality rate in Japan due to life-threatening illnesses is predicted to increase rapidly. Delivering appropriate care for people with terminal illness is an important, but largely neglected, role of the health care system in many countries. Recently, the concept of “Primary Palliative Care” has been proposed internationally, and is commonly used as a generic term regarding the activities of primary care physicians and home care nursing services. The tasks of primary palliative care include : 1) caring for people with life-threatening illnesses ; 2) contributing a palliative care approach early in the disease process ; 3) embracing all dimensions of care, including physical, psychological, social, and spiritual ; and 4) providing end-of-life care in the community. By building a system of primary palliative care that is consistent with our nation's medical system and values, care that meets the individual and familys' needs can be provided in the primary care setting which will further enable us to contribute to the community.

Background: In order to improve physicians' competence of palliative care, the PEACE project, a palliative care education program for physicians based on the Cancer Control Act, has been conducted throughout the country since 2008. The effectiveness and limitations of the current project management techniques and learning materials have not been determined. This study aimed to explore current problems with the PEACE project and to seek corrective strategies. Method: A workshop was held with 36 participants who had finished PEACE faculty-development programs, and involved brain-storming with physicians. The results of brain-storming sessions were qualitatively analyzed. Results: Most problems identified related to the burden, to the host, of holding the faculty-development program workshop. In addition, some problems related specifically to the individual host site or community involved. Conclusion: One strategy to improve these problems is to incorporate e-Learning to both expand the program and reduce the burden on the host site. In addition, workshop materials could be improved to include additional modules and revised guidelines. Palliat Care Res 2011; 6(2): 143-149

Purpose: The Palliative Care Education Program based on the Cancer Control Act has been held throughout Japan since 2008. The aim of this study is to identify changes attained through the program from the trainers' perspective. Method: The contents of the brain-storming sessions with the twelve trainers were qualitatively analyzed. Results: Six main categories of improvement were identified. These include: Reinforced cooperation; improved palliative care skills and knowledge; improved awareness of palliative care; improved understanding of the local palliative care resources; behavior modification of the participants; and development of in-hospital palliative care systems. Conclusion: Trainers recognized that holding the Palliative Care Education Program provides not only direct results such as greater knowledge and improved delivery of palliative care by physicians, but also indirect results such as enhanced cooperation and improved awareness of local palliative care resources.

Objectives：To clarify effectiveness of educational workshop in advance care planning (ACP) and clinical ethics based on education for implementing end-of-life discussion (E-FIELD) program. Methods：Pre-post questionnaire survey. We held workshop in ACP and clinical ethics based on E-FIELD program. We measured participant’s knowledge of ACP and difficulties of End-of-Life (EOL) discussion before and after the workshop. Results：In 37 participants, 34 participants finished the course. Improvement of knowledge of ACP and clinical ethics in post workshop survey was statistically significant (pre. 18.1 v.s. post 23.9, p<0.001, paired t test). In terms of difficulties of EOL discussion, 7 items in all 13 items questionnaire were improved significantly in post workshop survey (p<0.05, Wilcoxon rank sum test). Conclusion：Educational workshop in ACP and clinical ethics based on E-FIELD program may improve knowledge of ACP and reduce difficulties of EOL discussion.

Purpose: To investigate the job satisfaction, burnout, and related factors associated with palliative care-certified nurses. Methods: In 2005, we performed a mail-based questionnaire survey on palliative care-certified nurses was performed using job-satisfaction and Burnout Inventory. Related factors such as working place and clinical experience were also asked. A multivariate logistic regression analysis was employed to investigate relationship between burnout and the factors. Results: Of the 171 questionnaires delivered, 137 were returned (81.1%). The means of the job satisfaction subscales were as follows, professional status: 32.6±6.5, interaction: 26.4±6.7, autonomy: 17.5±5.2, doctor-nurse relationship: 8.6±3.6, administration: 28.5±8.5, pay: 24.0±7.8, task requirement: 13.2±5.4, and mean total, 150.6±29.8. Seventy palliative care-certified nurses (51%) showed signs of burnout. On the basis of multivariate logistic regression analysis, 9 factors, including those related to respondents working in cancer hospitals (odds ratio : 34.67, 95% confidence interval : 2.90-414.29) were observed to be associated with burnout. Conclusion: In order to facilitate the activities of palliative care-certified nurses, it might be useful to provide them with workplace-specific training and support. Palliat Care Res 2010; 5(1): 127-136

Background：A palliative care education program based on the Cancer Control Act, namely the Palliative care Emphasis Program on symptom management and Assessment for Continuous medical Education（PEACE）, has been run in Japan since 2008. Purpose：The aim of this study was to evaluate the usefulness of PEACE for clinicalpractice. Method：Focus group interviews were conducted with 12 physicians who attended the program and were chosen by theoretical sampling. Two investigators independently performed thematic content analysis. Results：Qualitative analysis identified five main categories of usefulness of the program：（1）acquiring knowledge of palliative care；（2）acquiring skills to provide palliative care；（3）mastering an attitude of focusing on suffering；（4）acquiring knowledge about home palliative care；and（5）standardizing knowledge of basic palliative care in the community. Three main categories for program improvement were identified, namely the content and structure of the program, as well as the method of running the program. Conclusion：PEACE may be useful in providing systematic education in basic palliative care through the acquisition of basic knowledge and skills, discussion of cases with colleagues, observing good communication by other physicians, and networking in the community.

We report that a case of maxillary sinus carcinoma with severe pain for radiation oral mucositis was successfully managed by using indomethacin spray. Fifty three-year-old male who was treated with radiation and chemotherapy including 5-FU for his maxillary sinus carcinoma developed oral mucositis with severe pain. Several medications such as diclofenac sodium (tablet), oxycodone hydrochloride (sustained-release tablet), morphine sulfate (fine granule), fentanyl (patch), azulene (gargle) and lidocaine (viscous) did not provide satisfactory effects on the pain control. We, therefore, tried to use indomethacin spray (0.2 mg/0.08 mL/push) with the daily dose of 9.6±5.2 mg (2-10 push/once, 1-11 times daily). Indomethacin spray provided dramatic effects on his pain relief with the significant reduction of pain score (face scale) from 2.4±0.4 to 1.0±0.1 (p<0.01). Mean time for pain relief was 8.7±2.2 min. after applying indomethacin spray. The effects of indomethacin spray on the radiation oral mucositis were evaluated by pain score in five patients with head-and-neck carcinoma. The pain score was improved in all cases after introducing indomethacin spray (before vs. after: 3.2±0.5 vs. 1.6±0.6, p<0.01) with the 8.1±3.8 mg/day. There was no adverse events associated with the use of indomethacin spray. The results suggest that the use of indomethacin spray is an alternative approach to control the pain for radiation oral mucositis in patients under radiation therapy for head-and-neck carcinoma.

The narcotics and psychotropic drug control laws were recently revised to enable the transfer of narcotics between narcotic retailers. However, there has been no study on the effect of this change to the law.For this reason, we studied whether there are any problems to this change in the law.We sent questionnaires to pharmacists at 3000 community pharmacies as a representative national sample, and 1036 responses were analyzed (response rate: 34.5%). Only 20.2% of pharmacists in community pharmacies answered that it is easy to obtain or transfer narcotics by applying for permission to transfer narcotics between narcotic retailers. The majority of pharmacists found the process to be difficult. The reasons for this included the complicated application procedure required by the regional bureau of health and welfare, and problems with the control of the prescribed narcotic's distribution as it is possible to apply only once for the supply of prescribed narcotics for the same patient. Furthermore, pharmacists cannot obtain the narcotics from a stock pharmacy. These results suggest that the current system of requiring permission for transfer of narcotics between narcotic retailers is inefficient and inadequate for maintaining a sufficient supply of narcotics for controlling the pain in cancer patients living in certain areas and overly complicates the procedure of obtaining narcotics by community pharmacies. It is important that the control of narcotics in Japan is changed to more closely resemble that of other commonly available prescription drugs, and allow narcotics to be obtained from stock pharmacies. Palliat Care Res 2010; 5(2): 213-218