Aims: To explore unmet needs and enhanced outpatient care functions of palliative care for patients with cancers, scrutinized records of outpatient visits in acute care and regional designated cancer hospital. Methods: A retrospective study was made for a total of 3136 consecutive visits from electronic records between April 2020–March 2023. Results: There were 630 unscheduled visits (20.1%) with 74.0% of them occurring during working hours; a quarter of unscheduled visits were after-hours. Of the total visits, 347 visits (11.1%) resulted in emergent admissions, and of the unscheduled visits, 305 cases (48.4%) were emergent admissions. Ambulances were called in 196 cases (56.5%) of emergent admissions. Moreover, the reasons for unscheduled visits statistically differed from reasons for non-admission cases (p<0.01). Conclusion: Patients’ illness trajectories and our results revealed that palliative care patients with cancers often experience unexpected physical and mental changes. To establish more effective outpatient care, we should construct structures to be available 365 days a year for palliative care patients and to instruct patients and their care givers in advance about warning signs for admission and how to access medical services.

In Japan, palliative care has mainly involved patients with cancer. However, palliative care should be provided for patients with other diseases. In addition, the need for palliative care for patients with medical conditions other than cancer is expected to increase with the aging population. Few reports have been published regarding palliative care team activity for patients with other medical conditions in Japan; accordingly, we meticulously scrutinized our team activity records and identified 64 cases from April 2019 to March 2023 in Osaka Rosai Hospital with 678 beds: the number of consultations, durations of interventions, patients’ demographics, request details, reactions from clients, and requests for interprofessional conference participations. Consequently, 42 cases out of all 64 cases, cardiology was the most common department and dyspnea, pain, and fatigue were frequently requested symptoms. The most frequent issue of interprofessional conferences was about continuous sedation. We recognized the need for timely publicity, easy access to the palliative team, success experiences of clients, and study groups to learn non-cancer diseases for penetration of palliative care activity.

To introduce early palliative care to patients, we have proactively used a palliative care screening tool to identify needs. We have emphasized not doing work in a routine manner, rather seeking to improve by continuous reevaluations. Because of a lack of feedback regarding changes in screening scores and actionable solutions derived from it, we executed a retrospective study about the effectiveness of our palliative care team and the identification of problems. All 91 cases studied meaningfully ameliorated their focused symptoms. However, we could not verify our team’s effectiveness because the backgrounds of patients who were eligible but not involved with our team differed significantly. The current study suggested that some patients missed opportunities to receive palliative care. We need to strengthen the system used with our patients as a safety-net so as not to overlook care opportunities by utilizing more effective screening methodology.