1) In addition to developing medical knowledge and skills, medical education should include training in the understanding and compassionate consideration of patients' feelings, such as anxiety.2) Fifth-year medical students at Wakayama Medical University engaged in role-play on medical care issues they raise themselves before being involved in clinical practice. This role-play has been incorporated in the curriculum to promote compassionate care.3) By performing all of the processes up to the presentation themselves, the students can enhance their knowledge of the topics. Thus, role-play on medical care issues is an effective means for understanding the importance of compassionate care and team communication.

Introduction: We described a patient with lung cancer who suffered from severe pain due to pelvic bone metastasis and opioid-induced delirium. Induction of subarachnoid analgesia using implanted intrathecal catheter almost abolished his pain and enable home palliative care. Case description: Seventy-year old man was admitted for intractable leg and hip pain due to pelvic bone metastasis and delirium induced by opioid. Although he was initially administered continuous subcutaneous morphine injection for opioid titration, delirium was deteriorated. Opioid rotation to oxycodone and increase in antipsychotic drugs could not improve his delirium. Epidural analgesia with local anesthetic and small dose of morphine improve his delirium with adequate analgesic effect. Finally, he was received intrathecal catheter implantation and discharged to home palliative care. Conclusion: Neuraxial analgesia may provide not only sufficient analgesia but also lower risk of delirium in patient who was administered high dose of opioids because of intractable cancer pain.

1) As part of a training program for compassionate care and community-based medicine, Wakayama Medical University began experiential training for first-year students at local welfare facilities for the elderly in 2006.2) Students were divided into groups of 2 or 3 and sent to welfare facilities for the elderly throughout Wakayama prefecture for 5 days of "on-the-job" training. After the training period, the students completed a questionnaire survey. Survey results from 2006 and 2007 were compared.3) The surveys showed that many students considered the training to be valuable because they could start communicating with the elderly residents of the facility by around the middle of the training period. On the basis of this result, we concluded that the 5 consecutive days of the program enhance the effectiveness of training.

1) The Department of Tourism Medicine was established at Wakayama Medical University in 2006. "Health tourism," a project of the department combining sightseeing with health care, has involved patients with a variety of diseases.
2) As a part of training to promote the compassionate care of patients, students participated in an overnight tour for patients with Parkinson's disease and kept the patients company all the time with various types of assistance.
3) The students could understand the daily condition of patients with Parkinson's disease, which they could not do in the hospital, and had favorable relations with the patients' families. This experiential practice was an effective means for promoting the compassionate care of patients.

Background: Factors requiring midazolam in addition to systemic opioids to control dyspnea in cancer patients have yet to be evaluated. Methods: We retrospectively analyzed data for cancer patients who received systemic opioids to relieve dyspnea from April 2019 to July 2021 in Wakayama Medical University Hospital, Japan. Patients were divided into an opioid-alone group and an opioid plus midazolam group, according to the treatment of dyspnea. Results: The total of 107 patients included 85 patients (79.4%) in the opioid alone group and 22 patients (20.6%) in the opioid plus midazolam group. Age<60 years (p=0.004) and male sex (p=0.034) was significantly associated with the addition of midazolam. Multivariate analysis found age <60 years (OR=5.34, 95%CI: 1.66–17.21; p=0.005) was associated with the addition of midazolam. Conclusion: Age <60 years is factor requiring midazolam in addition to systemic opioids to control dyspnea in cancer patients.