Our former independent palliative care center has become a palliative care ward in our new general hospital, and deceased patients continue to be discharged through the building’s main entrance. We compared the impact of this change on the discharge experience of bereaved families. As a result, the number of bereaved families who felt uneasy when their relatives were discharged from the hospital increased from 13% to 23%. On the other hand, the number of bereaved families who had a feeling of uneasiness when encountering the discharge of other deceased patients decreased from 52% to 28%. Although positive feedback was received for discharge using the main entrance, our findings emphasize the need for thorough consideration by medical staff of the manner of discharge in general hospitals. In response to bereaved families’ requests, our hospital has introduced a discharge system that allows families to choose whether to leave through the main entrance or through other entrances, aiming to improve the discharge experience.

Introduction: Although stop-and-go method is recommended for the introduction of methadone by the Japanese guidelines, it may temporarily result in inadequate pain control and/or serious side effects. We report our experience that alleviation of symptoms was achieved by introducing low-dose methadone at an early stage on top of preceding opioids for a patient with refractory cancer pain. Case: Tapentadol and an analgesic adjuvant were given to a 70-year-old man to treat the patient’s old anal pain due to recurrence of rectal cancer at the rectal anastomosis. However, since the pain was poorly controlled, methadone 5 mg was given adjunctively once daily. After methadone medication, remarkable alleviation of pain and improvement in QOL were observed. Discussion: To achieve a safe pain management, adding a small amount of methadone at an early stage, as in this case, may possibly considered.