Objective: This study aimed to investigate Japanese cancer patients’ perceptions of the scope of palliative care and factors that affect those perceptions. Methods: An anonymous, self-administered questionnaire was distributed to hospitalized patients and outpatients in designated cancer care hospitals in Japan. Data were first summarized using descriptive statistics. Then, using a χ² test followed by multiple logistic regression analysis, we compared patients who recognized palliative care as terminal care with those who viewed it as care that is relevant earlier in the disease course. Results: Of 3,622 questionnaires, 1,981 were completed (response rate: 54.7%). A total of 1,187 (59.9%) respondents perceived palliative care as care that could be implemented early in the disease course, whereas 414 (20.9%) respondents perceived palliative care as only relevant for the end-of-life stage. Respondents who had received palliative care for symptoms were significantly less likely to recognize it as terminal palliative care only than those who perceived that they were not the subject in the scope of care for symptoms. A diagnosis of advanced cancer and being under 40 years old were factors significantly related to the perception of palliative care as terminal only. Discussion and Implications: Our findings suggest that health care providers should be conscious of the possibility that palliative care practices affect patients’ perceptions of palliative care. Providing information about palliative care before occurring painful symptoms can help promote patients’ access to and understanding of it.

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.