Purpose: To develop a hematological cancer nursing difficulty (HCND) scale and analyze its reliability and validity. Methods: Self-reported questionnaires were distributed to nurses who were engaged in hematological cancer nursing. Results: As a result of explanatory factor analysis, six subscales comprising 35 items were extracted, which are as follows: to provide psychological support and decision making for patients and their families over a long period of time, understand the treatment and pathology of a variety of hematological cancers, alleviate the symptoms caused by chemotherapy and deterioration of the patient’s general condition, collaborate with physicians, manage the symptoms of the complications that occur after hematopoietic stem cell transplantation, and support the selection of the location and achievement to get end-of-life care. The reliability of the scale was confirmed using the Cronbach’s α coefficient of 0.96 (0.84‒0.94 for subscales). The criterion-related validity was confirmed by comparison with the 49-item Nurses’ Difficulty with Cancer Care (NDCC) scores. In terms of the validity of known groups, the HCND score for the nurses who were engaged for over 4 years in hematological cancer nursing was significantly lower than those who were engaged for less than 4 years in hematological cancer nursing. Conclusion: The reliability and validity of HCND were confirmed. Therefore, this scale may contribute in determining outcomes of educational or organizational interventions.

Herein, we report our experience of a patient whose recurrent pelvic cancer was complicated by obturator hernia after cervical cancer surgery. Regardless of the type of carcinoma, recurrent pelvic cancer tends to be complicated by neuropathic pain. On the other hand, obturator hernia is also often complicated by the similar neuropathic pain, which is referred to as Howship-Romberg symptom. However, it is relatively a rare disease that is considered difficult to make a diagnosis. In the case of this report, the patient had already developed neuropathic pain in the inside of the left thigh when she was admitted to our hospital, and began to develop a similar symptom on the right side during the course of follow-up. Despite the additional administration of analgesic adjuvant, the pain in the right thigh did not improve, and she began to develop heat sensation and redness in the extensive area from the thigh to the knee. CT scan revealed subcutaneous emphysema image and abscess formation. Based on the results of the examination, the patient’s right thigh was diagnosed as caused by the digestive tract incarcerated by obturator hernia rupturing into the right limb. The differentiation of obturator hernia is difficult to make, but its early stage diagnosis might make it possible to evade the aggravation of the symptom by manual reposition. In conclusion, when recurrent pelvic cancer was found to be complicated by neuropathic pain, it is critical to make an appropriate diagnosis taking into account the potential obturator hernia at an early stage.

Introduction: Though the animal assisted therapy and the animal assisted activity with animal visiting are widely introduced to general hospitals in Japan, the report of those activities in palliative care units (PCU) of general hospitals are few. Methods: In June 2013 therapy dogs started to visit our PCU with the help of NHO Japan Animal Association. We discussed on the effects and the problems as a part of the palliative care about this activity. Results: Three therapists with 3 therapy dogs came to our hospital twice a month and the total number of 487 patients took part in 73 sessions until September 2016. Those activities made the patients and their families felt better and their communications with staffs were improved. No adverse effects concerning the safety and health were observed in those activities. Discussion: The reliable training and infection control of animals can make easy the introduction of animal therapy to the PCU of a general hospital. Visiting of therapy dogs can provide the healing to not only the patients and their families, but also the staffs in the PCU.

Objective: This study aimed to (1) understanding the activities, job satisfaction, and burn out of certified nurses in palliative care, and (2) develop suggestions for increasing job satisfaction and preventing burnout among these nurses. Methods: Questionnaires were sent to 362 certified nurses in palliative care in 2008 with a series of questions on their background, activities, job satisfaction, and burnout according to the burnout scale. Results: Logistic regression analysis was performed on 226 completed and returned. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation questionnaires. Attributes associated with the group of respondents who reported higher job satisfaction included “higher age,” “long tenure in the job category,” and “having well-defined objectives.” The burnout group, which accounted for 44% of the respondents, was associated with the factors of “lower job satisfaction score,” “unsatisfactory working location and/or conditions,” “lower satisfaction about social recognition of their profession,” and “being unmarried.” Conclusion: Higher job satisfaction and prevention of burnout among the respondents were associated with higher age and good communication within the organizations. The findings suggest that interventions are required to support nurses who are younger and face difficulties in communication within the organizations.

Purpose: In Kasugai City Hospital, we have introduced palliative care clinical pathway with a focus on decision-making support on the intention of recuperation location in addition to symptom relief. In this study, it is intended to explore the factors that make it difficult to home discharge of cancer inpatients with the intention of discharged home on the basis of the information on the clinical pathway. Methods: The subject patients were cancer inpatients who had expressed the intention of the discharge to the home during period from June 2014 to August 2015. We examined the medical records of the target patient retrospectively. Logistic regression analysis was performed in order to clarify the factors that make it difficult to home discharge. Results: Of 43 patients, 25 patients (58.1%) were discharged from the hospital to the home. As a result of logistic regression analysis (multivariate analysis), delirium and living alone have been extracted as the predictive factors that makes it difficult to home discharge. Conclusion: Delirium and living alone have been suggested as the factors that makes it difficult to home discharge of patients who wish to home discharge. Early detection and early treatment of delirium are important, and early collaboration between the hospital discharge support department and palliative care team for the living alone patient is also necessary.

We established the Early Palliative Care (EPC) outpatient department for patients who had received chemotherapy at other hospitals in August 2015. We retrospectively investigated medical records of patients who consulted the EPC outpatient department and patients who consulted the Medical Oncology outpatient department of our hospital between August 2015 and January 2016. The length of the first medical examination, the contents of the medical examination, period to hospitalization and period to death were investigated. Nineteen EPC outpatients and 11 Medical Oncology outpatients consulted a total of 80 times and 117 times at the respective outpatient department. The median length of the first medical examination in the EPC and Medical Oncology outpatient departments was 45 minutes (range, 10-106 minutes) and 38 minutes (range, 23-60 minutes), respectively (p=0.17). The contents of the examination in the EPC outpatient group included discussion about symptom management, coping, etc. Five patients (26%) in the EPC outpatient group passed away less than 60 days from the first medical examination. It would be possible for palliative physicians to establish and manage an EPC outpatient department in Japanese hospitals. However, some patients had late referral to the EPC outpatient department. Public awareness about EPC and the practice of EPC are important.

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.

The aim of this study was to examine the usefulness of opioid initiation therapy with oral tramadol (TD) by comparing its efficacy and safety with that of sustained-release oxycodone (OXC). Although the complexity of clinical setting seemed to make difficult to carry out strict evaluation of TD initiation therapy, a higher number of patients experienced unmanageable pain with TD initiation therapy than with OXC. Almost half the TD-initiated patients switched from TD to another analgesic in earlier phase than those on OXC did. However, the number of patients who changed the initiation opioid because of side effects was larger with OXC than it was with TD. The incidence of nausea and sleepiness was significantly lower with the TD initiation therapy than it was with OXC. Additionally, cases of nausea observed after OXC administration were also significantly fewer in patients who switched opioids from TD to OXC than in the OXC-initiated patients. In the case of OXC-initiation, the number of onset of side effects was the highest immediately following opioid initiation, and then it gradually decreased. However, in switched case from TD to OXC, they mostly did not develop side effects after OXC administration. These results suggest that opioid initiation with TD could be a useful alternative for pain management with fewer side effects; however, careful monitoring of pain relief is essential, especially in the early phase of TD initiation.

The aim of this study was to investigate the dementia provision for elderly cancer patients in designated regional cancer centers. A survey was mailed to 389 designated regional cancer centers from February to June, 2015. A total of 188 facilities responded (response rate: 48.3%). 5.3% of the respondents used two manuals (on basic dementia care and the behavioral and psychological symptoms of dementia) to check whether these centers were following appropriate measures. About 50% of the respondents performed dementia assessments by the primary care team. 29.3% of the respondents maintained the system of the education and training of dementia care. Therefore, dementia provision for elderly cancer patients in designated regional cancer centers needs to improve the education of dementia care.

Purpose and method: The aim of this study was to explore the child-care and housework difficulties experienced by fathers during their wife’s cancer treatment. 7 men who had 0 to 15-year-old children when their wife was diagnosed with cancer were interviewed using a semi-structured interview format. Main results: Subjects’ report of their difficulties was assessed using the following 3 categories: 1) burden of housework 2) stress from life together with the in-laws 3) contact with schools and nurseries. The influence of background factors was considered: a) experience of housework in the family prior to his wife’s illness; b) experience of living with in-laws; c) degree of cooperation with their parents; d) degree of trust in their relationship with their in-laws; e) child’s/children’s age; f) availability of childcare resources; and g) assistance prepared by their wife. Providing information on child care and housework support or opportunities for exchanging information with other husbands in similar situations can be considered valid forms of assistance for fathers whose background factors may predispose them to a greater degree of hardship in child care and housework during their wife’s illness.