The primary aim of this study was to investigate the reliability and validity of a measurement tool to quantify the quality of communication and cooperation among health care providers in a region. A total of 476 health care professionals were enrolled. For the 25-item scale, the internal consistency was excellent. Factor analyses identified 7 underlying factors, such as easy communication with health care providers in other institutions, understanding the role of other disciplines in the region, and knowing the face, name, and the way of thinking. The total score had weak negative but significant correlations with the cooperation subscale of the Palliative care Difficulties Scale. The total score was also significantly associated with the general evaluation of communication and cooperation in the region, the number of participations in whole-region multidisciplinary conferences, the number of persons to whom the respondent could ask about palliative care in the region, and clinical experience in the region. In conclusion, this scale can measure the quality of communication and cooperation among health care providers in a region with acceptable reliability and validity.

Purpose: This study was conducted to verify the reliability and validity of a scale evaluating the quality of communication and cooperation among medical, nursing, and welfare services in a region. Methods: To apply "a measure to quantify the quality of communication and cooperation among health care providers in a region" (Morita et al, 2013) developed for health care professionals engaged in the care of homebound patients to broader profession and disease categories, the measure was modified to newly establish the 26-item "measure to quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region." In total, 362 health care professionals were enrolled in this study. Results: The internal consistency was excellent. Exploratory factor analyses identified the factor structure as being identical to that of the original scale. The total score had negative but significant correlations with subscales for difficulties in regional cooperation on the Palliative Care Difficulties Scale. The total score was also significantly associated with the general evaluation of communication and cooperation in the region, the number of participations in whole-region multidisciplinary conferences, and the number of persons to whom the respondent could inquire about support. Conclusion: This scale may be useful for describing the extent of global communication and cooperation among medical, nursing, and welfare services in a region.

To explore the concept of “kao-no-mieru kankei (face-to-face relationships)” and effects on community care networks, questionnaire and interview surveys were conducted involving 207 and 5 health care professionals, respectively. The item “face-to-face relationships” were significantly correlated with “I know his/her name, face, and way of thinking” “I understand the principles and current status of the facility” “I know his/her characteristics and how to deal with them”, and “I know what each person does” (p>0.7). An interview survey showed that “face-to-face relationships” consisted of “know the name and face” “know what s/he is like” and “trust in each other”. As effects of “face-to-face relationships” on community care networks, the following items were extracted: “It facilitates easy communication” “It provides me with information on who is responsible for which problem” “It facilitates smooth communication by changing my approach” “It makes me effective at work” “It gives me a sense of intimacy”, and “it gives me the responsibility”. Thus, preliminary findings of the concept and effects of “face-to-face relationships” were obtained.

Insomnia in advanced cancer patients has a highly negative impact on the patients, their families and caregivers. Insomnia is principally managed by pharmacological therapy； however, most advanced cancer patients are unable to receive oral medications. This prospective audit study investigated the efficacy of single—dose subcutaneous administration of flunitrazepam for treating insomnia in patients with advanced cancer. Sleep evaluation was conducted using the St. Mary’s Hospital Sleep Questionnaire. The primary endpoint was the quality of sleep； the secondary endpoints comprised other subscales of total sleep time, sleep latency and adverse effects. We enrolled 30 patients. The average dose of flunitrazepam dose was 0.9(0.1)mg. The good response rate for the quality of sleep was 90％. The total sleep time and sleep latency were 7.5(3.2)h and 31(9.1)min, respectively. Two patients were newly diagnosed with delirium during the study. The mean respiratory rate decreased(15/min before treatment to 14/min after treatment, P＝0.01) without any critical events. Single—dose subcutaneous administration of flunitrazepam may be potentially efficacious and simple in treating insomnia in advanced cancer patients.

Purpose: To clarify factors associated with the Japanese perception of whether they can live at home until death with the inclusion of knowledge and beliefs about end-of-life. Methods: A questionnaire survey was conducted on the Japanese general population who participated in a lecture meeting about palliative home care (N=61, effective response rate, 100%). Results: Ten (16%) responded they could live at home until death. Barriers to end-of-life home care were "Home care would burden my family (80%)," " Family and I are anxious about emergency care when I get worse (59%)" and "Family and I are anxious about whether I can enter a hospital emergently when I get worse (52%)" in that order. From the multivariate logistic regression model, respondents who expressed "Opioids cause addiction (OR, 95% confidential interval (CI):0.29, 0.09-0.99)" and "Artificial hydration and nutrition should be continued as the minimum standard until death (OR, 95%CI:0.39, 0.16-0.95)" were more likely to perceive that they could live at home until death. Conclusion: The empowerment activity for the general population regarding correct knowledge about palliative care, benefit and disadvantage of life-sustaining treatment, and correct knowledge about home care is important for the end-of-life patients who want to live at home until death to achieve their wish.

The primary aims of this study were; 1) to investigate the appropriateness of the analgesic therapy in hospitalized cancer patients, and 2) to explore the effects of the screening system by a pharmacist-palliative care physician screening team on analgesic regimens.
The pharmacist-palliative care physician screeningteam screened consecutive cancer patients about the adequacy of analgesic treatments and provided written recommendations to primary physicians. Inclusion criteria were cancer patients admitted to oncology wards, not having been consulted to palliative care team, and receiving opioid or chemotherapy. Of 62 patients screened, analgesia was inadequate in 44%, and preemptive pharmacological treatments for opioid-induced nausea and constipation was lacking in 42% of 43 patients who had received opioids. The team provided a total of 80 recommendations for 52 patients, and primary physicians followed 94% of the recommendations within one week. The pharmacist-palliative care physician screening team may contribute to better analgesia in patients not having been consulted to the specialized palliative care service.

As measuring the quality of palliative care is considered to be important, quality indicators (QIs) that are able to extracted from medical database or from medical chart review have recently been developed in Western countries. In this paper, we reviewed the development of QIs and actual measurements collected in palliative care settings. The present results indicate that QIs based on data extracted from such sources as the cancer registry, medical claim, and palliative care databases, include items regarding aggressive treatment, hospice use, and intensive care units visits. Furthermore, QIs based on data extracted from medical chart reviews were developed for use with community-dwelling elderly patients. As with other QIs, QIs utilized at ICUs, QIs utilized at nursing homes, and evaluation of care from the perspective of bereaved families was conducted. In the future, QI items and methods appropriate for Japanese medical settings should be developed and their feasibility, reliability, and validity should be examined.

Purpose: Improving knowledge of palliative care among cancer patients and the general public may be useful for achieving a better quality of life for cancer patients. The aim of this study was to identify the actual situation after the dissemination of leaflets, booklets, and posters as a part of a regional palliative care program. Methods: We distributed leaflets, booklets, and posters on palliative care to 257 administrative and health institutions across the region. We also visited 216 institutions (84%) to observe the actual situation and performed interviews in 133 of the institutions (62%). Results: Overall, 58% of the institutions used the leaflets, booklets or posters. Public halls, libraries and hospitals used them at a rate of 65% or higher. Interviews identified 7 themes, including "explaining the aim of the project before dissemination is important", "few cancer patients or even the general public visit", "staff made various efforts to display the items after dissemination", and "staff learned from the leaflets and booklets, even if cancer patients seldom visited". Conclusion: The dissemination of leaflets, booklets or posters throughout the region might be useful for conveying accurate knowledge about palliative care not only for cancer patients and the general public, but also for health care professionals. Target institutions should include public halls, libraries, and hospitals, and pre-dissemination discussions about the aim of the project and what kinds of people visit the institutions in addition to post-dissemination follow-up may be useful. Palliat Care Res 2010;5(2): 171-174

The aim of this study was to explore the changes in the rates of discharge to home from the palliative care unit in the region where the regional palliative care intervention program, their home death rate, and their ratio to whole home death cancer patients in the region. During the study period, the palliative care unit changed an administrative policy actively end-of-life care to support patients at home. The rate of discharge to home from the palliative care unit increased 11% to 22% during the study period, and their home death rate increased 10% to 41%. The overall home death rate of cancer patients however remained 6.8% to 8.1%, and their ratio to whole home death cancer patients in the region was less than 10%. To establish health care system to support cancer patients at home, changing administrative policy of palliative care units is insufficient and increasing quality community palliative care resources seems to be essential.