Purpose: The proportion of terminally ill cancer patients who were discharged home from a hospice/palliative care unit and subsequently died either at home or in the palliative care unit, whose final place of death was consistent with their intended place of care, remains unclear. This study aimed to clarify the consistency between the preferred and actual place of death. Methods: This study was a supplementary study to a multi-institutional bereavement survey conducted in 2018. Results: Responses were obtained from the bereaved families of 202 patients who died at home and 157 patients who died in a palliative care unit. Among them, 80% of home deaths and 82% of palliative care unit deaths were consistent with the stated end-of-life care preference. Among the 22 cases who preferred to die in a palliative care unit but died at home, the most common reason was the availability of physicians and nurses who could provide end-of-life care at home. Among the 11 cases who preferred to die at home but the patients died in a palliative care unit, the most common reason was insufficient pain management at home. Conclusion: Approximately 80% of patients died by their end-of-life care preference, suggesting that many were able to die in their preferred location.

Objective: To identify effective strategies to provide high-quality palliative care in settings where palliative care specialists are scarce, particularly in Japan. Methods: A scoping review of literature (in English) was conducted using Arksey and O’Malley’s methodological framework. Electronic databases (MEDLINE, CINAHL, and the Cochrane Library) were searched and supplemented with a manual search of relevant journal articles. Results: Nine studies met our inclusion criteria. Four key strategies have emerged: (1) developing a video consultation system to improve the timeliness of care; (2) providing online consultations by specialists to support general practitioners; (3) training nurses to manage the palliative care process; and (4) transferring knowledge and information from experts to non-specialists. Conclusion: Based on these strategies, creating a system tailored to the specific needs and readiness of palliative care in Japan is necessary. The effectiveness of these strategies should be evaluated in future research.

Background: Recognizing the importance of multidisciplinary collaboration during treatment family conferences is increasing in critical care settings. We aimed to elucidate how critical care specialist nurses engage in the family conference process in terms of the actual discussions held, the recommended topics, and their perspectives regarding transfer of critical care patients to general wards. Methods: This self-administered nationwide survey was conducted between October and December 2020, targeting a random sample of 740 critical care specialist nurses. An anonymous questionnaire based on established guidelines and pilot tests was used to assess the level of engagement with the family conference process, content of discussions, considerations regarding withholding or withdrawing treatment, and perspectives concerning patient care location and discontinuation of life-sustaining treatments among the surveyed nurses. Results: Of the 396 returned questionnaires (response rate, 51.9%), 384 were analyzed. Less than 35% of the nurses consistently participated in family conferences and ensured that decisions regarding withholding or withdrawing life-sustaining treatments were re-evaluated following the conferences. Discussions focused predominantly on the patients’ physical aspects, whereas the nurses believed that patients’ values and preferences should be discussed. More than 70% of the nurses supported transferring patients from critical care settings to general wards for end-of-life scenarios. Conclusions Critical care specialist nurses in Japan exhibit limited engagement in family conferences and often fail to address their patients’ values and preferences. Educational programs and enhanced interprofessional collaborations are warranted to improve nurse involvement in family conferences and ensure continuity of care between critical care and general ward settings.

Objectives: This study aimed to describe the difficulties faced by physicians in providing palliative care to patients with cancer in facilities without palliative care specialists. Methods: Semi-structured interviews were conducted with 11 physicians involved in cancer treatment who were affiliated with facilities having no palliative care specialists such as Diplomate or Board Certification of the Specialty Board of Palliative Medicine of the Japanese Society for Palliative Medicine. The interview data were analyzed using qualitative content analysis. Results: The participants had “difficulties in palliative care consultation” because they could not consult with specialists or medical staff at their own facility, when immediate response to cancer symptoms was required. This was partly due to “difficulties in regional cooperation”. In addition, the participants had “difficulties in alleviation of symptoms” for highly complex symptoms of patients with cancer. Behind these difficulties, there was “difficulties in foundation of providing palliative care for individual physicians” including limited time available to the participants. Conclusion: These findings show that there is a necessity to establish a continuous external consultation system for specialists to respond to the immediacy of changes in symptoms and highly complex symptoms.

A secondary analysis of data from national bereavement surveys conducted in 2014, 2016, and 2018 was conducted with the aim of identifying the contribution of various patient and bereavement backgrounds to the outcomes of the Bereavement Survey. The data were evaluated in terms of structure and process of care (CES), achievement of a desirable death (GDI), complexity grief (BGQ), and depression (PHQ-9). The large data set and comprehensive analysis of bereavement survey outcomes clarified the need for adjustment of confounding variables and which variables should be adjusted for in future analyses. Overall, the contribution of the background factors examined in this study to the CES (Adj-R2=0.014) and overall satisfaction (Adj-R2=0.055) was low. The contribution of the GDI (Adj-R2=0.105) was relatively high, and that of the PHQ-9 (Max-rescaled R2=0.200) and BGQ (Max-rescaled R2=0.207) was non-negligible.

Purpose: Palliative care implementation should take into account the perceptions and acceptability of healthcare providers. This study aimed to identify physicians’ perceptions of palliative care and barriers to palliative care practice in the critical care setting. Methods: A nationwide, self-administered questionnaire was distributed to physicians working in intensive care units, and free-text data were qualitatively analyzed. Results: The questionnaire was sent to 873 respondents, and 436 responded (50% response rate). Of these, 95 (11%) who responded to the open-ended sections were included in the analysis. Conclusion: Japanese physicians working in ICUs recognized that palliative care was their role and practiced it as part of their usual care. They felt, however, that the practice was difficult and not sufficient. Barriers to practice included the lack of human resources and availability of palliative care teams, and the lack of uniformity in the perception of palliative care in the critical care setting.

Objective: This study aimed to investigate the feasibility of a patient registry system for assessing PCT (palliative care team) by PRO (Patient-reported outcome) in Japan. Methods: We operated a patient registry system with electronic data collection at eight hospitals in 2021 in Japan. We consecutively included newly referred patients for a month and followed up with them for a month. IPOS or ESAS obtained as PRO at the start of the intervention, three days later, and every week after. The primary endpoint was the response rate to the symptom rating scale by patients and providers. Results: 318 patients were enrolled. The patient response rate was 59.1% at intervention and 37.0% after intervention, and the medical provider response rate was 98.4% at intervention and 70.3% after intervention. Interviews with PCT members indicated that participants required support to input PRO responses required support and paper questionnaire was better and that managing the survey date and overall management was burdensome. Discussion: Although only about half of the patients were able to respond to the PRO, this was the same level as in previous studies. The system and its operation method have many problems. We found that improvements such as reducing items and making the patient interviews paper-based are necessary to expand the system nationwide.

Background: In Japan, a nation-wide education program for primary palliative care (the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education: PEACE) was established in 2008. In 2018, this program was revised from a two-day workshop to a hybrid program combining e-learning with a one-day workshop. This study aimed to assess the changes in participant knowledge and difficulties after having completed the revised education program. Methods: The subjects of this study were all participants who completed the revised program from April 2018 to March 2019. We conducted a pre-post survey via the e-learning system, and measured scores on the palliative care knowledge questionnaire to evaluate PEACE (PEACE-Q) and Palliative Care Difficulties Scale (PCDS). Results: A total of 11,124 participants completed the revised program from June 2018 to March 2019. Participants’ knowledge improved significantly according to the PEACE-Q with a total score of 24.1 and 30.0 (p<0.0001), and difficulties diminished as indicated by the PCDS with a total score of 45.2 and 39.2 (p<0.0001). Participants in different professions obtained similar results. Conclusion: Participants’ knowledge and difficulties improved after the revised nationwide primary palliative care education program. Similar results were obtained by participants in different professions.

Objectives: Elucidate recognition of end-of-life care by nursing care staff in elderly care facilities, and factors influencing such recognition. Methods: We conducted an internet questionnaire with 500 nursing care staff working at elderly care facilities across Japan, and an interview with 10 nursing care staff out of 500. Results: In the questionnaire, facility policies (41%) and cooperation with medical staff (38%) were selected as facilities and systems that are important for end-of-life care, and as a concern, sudden change in the condition of the patient, leading to death (53%) was selected. The interview showed that nursing care staff had a certain level of anxiety regardless of their experience with end-of-life care, with participants discussing their thoughts on how systematic learning of, and actual experience in, end-of-life care changed end-of-life care. Conclusion: Our study showed that systematic learning and experience of end-of-life care were important factors in recognition of end-of-life care by nursing care staff when providing such care in elderly care facilities.

The aims of this study are 1. to evaluate the usability of workshop to introduce and manage distress screening effectively and efficiently and to use it for cancer patients and their family and 2. to consider the appropriate subject of workshop. All of the participants answered the questionnaire on the site (n=51). Their knowledge about screening practice, various screening tools and how to use screening tools and data from screening tool were significantly improved after the workshop. The workshop was highly regarded by participants. Thirty-eight of fifty-one patients responded to web questionnaire three months later (Response rate: 75%). More than thirty percent of participants put into practice what they learned in the workshop. The workshop decreased factors to interfere screening practice three months later. Knowledge about how to use screening tools was negatively correlated to number of cancer patients at hospital where participants worked and number of their hospital beds. And factor to interfere screening practice was negatively correlated to how long participants were involved in palliative care team. This study indicated the usability of workshop to spread screening triage program regarding cancer patients’ distress. The workshop may be appropriate for medical staffs who have relatively much experience of palliative care team and who have difficulty in screening practice at designated cancer hospitals where number of cancer patients is relatively large.