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.

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.

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.