Objective: The aim of this study was to investigate the current status of the palliative care provided by long-term care unit that was established together with palliative care unit (PCU). Methods: Self-reported questionnaires were administered to long-term care unit administrators at 24 facilities that was established together with PCU. Questions included: managing the use of narcotic drugs, situation about receiving cancer patients, situation about cooperation with PCU, and difficulty with palliative care. Results: Eighteen (75%) facilities responded to the questionnaire. Fourteen facilities of respondents reported that narcotic drugs were available and usable in long-term care unit, and ten facilities reported that the narcotic drugs could be used in the same way as PCU could. Ten facilities reported that they had doctor(s) knowledgeable about palliative care or prescribing narcotic drugs, and 11 facilities reported that they had nurse(s) experienced about palliative care. Cancer patients were accepted in all 18 long-term care units. Transferring from long-term care unit to PCU due to medical condition changes after hospitalization had been carried out in 17 facilities. Unit administrator’s perceived difficulty lack of staffing, lack of staff expertise and education, and issues surrounding narcotic drug management. Conclusion: These long-term care units were providing palliative care for cancer patients in cooperation with PCU. The survey results indicated the need for solving human resource, educational, and administrative problems.

Purpose: We investigated the benefits and problem of the palliative care provided by long-term care unit through a survey of staff in palliative care units (PCU) and long-term care units. Methods: Self-reported questionnaires were administered to staff who engaged in PCU and long-term care units. Questions included: awareness of WHO palliative care definition, and, the general idea on palliative care, possibility of cooperation with PCU, advantages / disadvantages, and idea for non-cancer palliative care in long-term care unit. Results: We got responses from 248 medical and nursing-care staff. The percentage of “knowing” the WHO definition was 76.5% in medical staff / 32.3% in care worker, 87.6% in PCU experience / 46.5% in non-experience. Categories of responses are good, advantageous, problematic, difficult requirement, difficulty, etc. The main answers were the difficulty of care, problems of knowledge and technique, and points of problems related to personnel shortage. Medical staff or PCU experienced staff pointed out needs of palliative care and improvement of knowledge and skills. Conclusion: Opinions acknowledging the benefits and necessities for palliative care of long-term care units and a number of problems were revealed.

Background: The authors, in collaboration with a nursing college and healthcare organizations, initiated a project, "Tama District (a suburban area in Tokyo) End-of-life Care Networking" for nurses, in order to provide networking opportunities for nurses who would like to work together in their local community. A survey was conducted to identify those nurses' needs before initiating this project. Result: The first networking meeting was held based upon the survey results, and 39 nurses participated. The participants were from 14 hospitals, six home-visit nursing stations, and one home care support office in a northern area of Tama District and its surrounding areas in Tokyo. After having this meeting, it was identified that these nurses were highly motivated in providing better end-of-life care, and they had strong desires to network together and to exchange information about challenges and opportunities in their practice. Conclusion: Future issues and implications included the following: (1) Providing continuous opportunities for nurses with such meetings, and refining and updating programs to meet their needs; (2) Facilitating face-to-face relationships among individual nurses in this local community in order to facilitate better collaboration; (3) Initiating local activities that may improve and enhance nursing practice for patients and families who have health issues in their daily life.

Purpose: The review of the published reports was performed with the aim of systematic collection and integration of information related to "signs and symptoms" along with their changes among patients after upper gastroesophageal surgeries. Methods: The PubMed and the Japanese healthcare literature database were searched by the following keywords:"gastric cancer" "esopha∗ cancer" "surgery" and "symptom" As a result, 37 articles related to gastric or esophagus cancer were identified. The data were extracted according to each sign and symptom, and were evaluated and discussed. Results and Conclution: Standardized instruments for gastrointestinal symptoms included evaluations about dysphagia, difficulty in swallowing, reflux etc. The incidence of signs and symptoms, or postsurgical recovery processes are different among individual patients. Healthcare professionals should support patients continuously and systematically so that patients can take appropriate health maintenance behavior according to their signs and symptoms.

Purpose: This study aimed at identifying the nature of nursing for patients who have appearance changes due to cancer treatment. Methods: Nurses’ focus group interviews were conducted at two cancer hospitals. The data were analyzed qualitatively. This study was approved by the Research Ethics Committee at the study hospitals. Results: Six focus group interviews were conducted, including a total of 21 participants. The participants’ mean age was 39.2 (SD=6.0) years. Their mean years of professional experience was 16.3 (SD=5.8) years. The participants also included a total of 16 Certified Nurse Specialists and Certified Nurses. Interviews took an average of 42 minutes. Four core categories derived from interviews were: “providing information in advance that is necessary for those having the risk of appearance changes to predict and to prepare,” “providing support to enhance patients’ self-care according to the processes of appearance changes in their daily lives,” “advocating patients’ decision to improve their quality of life,” and “utilizing specialty of multi disciplines through care coordination and collaboration.” Conclusions: Further study will systematically analyze details of appearance changes and necessary care associated with different cancer treatment methods, organ sites, and treatment cycles.

Purpose: This study aimed at identifying difficulties among post thoracic esophagectomy cancer patients during outpatient follow-up. Methods: Patients who had radical esophagectomy at a cancer center hospital in Japan were prospectively observed and were interviewed by a certified nurse assigned at esophageal surgical outpatient division. Their responses were documented in medical records and were analyzed by content analysis method. This study was approved by the study hospital's research ethics committee. Results: The data from 66 patients were obtained. Content analysis yielded 221 extracts, 25 categories, and 65 codes of difficulties, including: concerns or signs/symptoms associated with dietary intake, physical activity, and anxiety. Implications: The majority of post-thoracoabdominal esophagectomy patients experienced multiple dysfunctions and symptoms after discharge. The results underscore the significance of nurses' role in assessing and instructing patients to address these issues.

Background: Patients having thoracic esophagectomy, a standardized treatment for esophageal cancer patients in Japan, are known to have various postsurgical signs and symptoms for a period of time. The current status of nursing interventions at outpatients need to be clarified. Purpose: This study aimed at identifying the nurses' interventions for cancer patients at the outpatient setting who previously had thoracic radical esophagectomy. Methods: Patients who had esophagectomy at a cancer center hospital in Japan were prospectively observed and interviewed by outpatient nurses between January 2009 and December 2010. Their documented responses in medical record were prospectively investigated and were qualitatively analyzed via content analysis method. This study was approved by the study hospital's research ethics committee. Results and discussion: The data analysis of nursing interventions for 66 patients yielded 372 extracts, 12 categories, and 74 codes. Nurses were assessing patients' signs and symptoms affected by postsurgical changes, and were utilizing patients' active self-monitoring skills. The results also showed the significance of facilitating postsurgical recovery in relation to nutritional intake and physical activity in patients' daily life. Implications: Based upon the study results, the development of a systematic program is underway, which facilitates esophageal cancer patients' postsurgical recovery.

Introduction: The purpose of this study was to identify the current status, issues, and training needs of nurses in terms of the appearance care for patients who undergo cancer therapy. Methods: Self-administered anonymous surveys were mailed to a total of 2,025 nurses. Potential respondents included five nurses who work at various departments in all the 400 Designated Regional Cancer Centers and Hospitals in Japan, or who accessed the Appearance Care Research Network website voluntarily and registered for study participation. Survey items included demographics and the 94 items concerning appearance care for changes associated with cancer therapy. The data analysis included descriptive statistics and logistic regression analysis to identify correlates of the provision of appearance care. Textual responses were qualitatively and descriptively analyzed. Results: Seven hundred and twenty six (35.9%) usable responses were returned. The respondents had a mean age of 42.5 (a range of 24 through 62) years. As a result of the survey, 93 out of 94 care items were carried out by respondents. Correlates of healthcare professionals’ appearance care provision included “collecting information from various sources” and “having confidence in providing care.” Seventeen categories of issues related to appearance care were created, including various items such as “appearance care is not standardized, and recognition level is different between healthcare professionals.” Discussion: Based upon the identified issues and needs of this study, an effective training program will be developed for healthcare professionals who provide appearance care for patients undergoing cancer therapy.