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.

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.

Objectives: The aim of this study is to explore prevalence and determinants of complicated grief, depressive symptoms, and suicide ideation among the relatives whose family members died in palliative care units. Methods: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the Center for Epidemiologic Study Depression Scale (CES-D), Inventory of Traumatic Grief (ITG), the item concerning suicide ideation, Care Evaluation Scale (CES), and Good Death Inventory (GDI). Results: Of the 653 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 67%). The results showed 10 (2.3%) respondents with complicated grief and 153 (43.8%) with depressive symptoms. Suicide ideation was appeared among 52 (11.9%) respondents. Multiple regression analysis revealed that ITG was signicicantly associated with both CES and GDI. Patiens' age at death and pre-bereavement health contributed to the suicide ideation of the bereaved family members. Conclusion: The prevalence of complicated grief and depressive symptoms among the relatives whose family members died in palliative care units were 2.3% and 43.8%, respectively. The rates of suicide ideation was 11.9% of respondents. The results suggested that the evaluations about structure and process of palliative care, and quality of death contribute to better adjustment of the bereaved.

Objectives: The purpose of this study is to clarify evaluations and needs of bereavement services among the bereaved whose family member died at palliative care units. Methods: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the items concerning bereavement services provided by palliative care units and other resources, and the Center for Epidemiologic Study Depression Scale (CES-D). Results: Of the 661 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 68%). The results revealed that 49% of respondents received "memorial cards". Bereavement services were evaluated positively by 88-94% of respondents. The bereaved relatives with higher level of depressive symptoms signicicantly asked for bereavement services. Conclusion: These findings did not suggest the efficacies of some beravement services provided by a specified unit, but that of each service itself at palliative care units. And this result supported the notion that all the bereaved did not equally want any beravement services.

Objective：Care Cafe® aims to remove the barriers between medical treatment, nursing, and welfare, particularly with regard to actual practice. This study was conducted to investigate the changes in local integration using the Care Cafe®. Method：Participants in Care Cafe® filled out the questionnaire before and after attending. We used the Mixed Method to compare the results. This method provides analysis on changes in“quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region”scale points, as well as content analysis on the free-opinion space. Results：The“quantify the quality of communication and cooperation”scale points increased significantly overall, as well as on the subscale. The effect size ranged form 0.32 to 0.36. We also had various successes in the content analysis of the free-opinion space, such as building face-to-face relationships in multiple occupations, that being one of the main purposes of Care Cafe®, as well as providing support, learning through discussion, and generating social capital. Conclusion：Care Cafe® may be a useful tool for improving local, multi-discipline cooperation involving medical treatment, nursing, and welfare.

Objectives:To determine the factors that influence the decision maker regarding end-of-life (EOL) care and to disclose how aggressive care in the last week before death, place of death, and quality-of-life (QOL) affected the decisions made. Methods:The subjects were 409 bereaved family members (cause of death included cancer, stroke, heart disease, and pneumonia) that registered with an internet research agency. Decision-making was controlled either by the patient, family, or physician or shared by the patient, family, and physician. Results:The results of a multinomial logistic regression analysis demonstrated that when a family controlled decision-making, they were less likely to report patient-family EOL discussion [odds ratio (OR)=0.52], and that the patient had good communication with the physician (OR=0.77); they were also likely to report that the patient had dementia (OR=1.94). Families who reported physician-controlled decision-making (vs patient controlled) were less likely to report that the patient had good communication with the physician (OR=0.62). Cardiopulmonary resuscitation in the last week and place of death were not associated with the decision maker. EOL QOL was associated with EOL care of the decision maker. When a physician controlled decision-making, patient EOL QOL was at its lowest. Conclusion:To improve patient-controlled decision-making, it is critical that patients, families, and physicians have more communication regarding EOL care.