In this study, we conducted interviews with staff members who had experience in discharge coordination to clarify the characteristics and efforts of discharge coordination for patients with pediatric cancer toward end-of-life. Focus group interviews were conducted with 11 individuals, including six medical social workers and five nurses (acceptance rate: 84.6%) and a qualitative inductive analysis was conducted. Seven categories were identified as characteristics of discharge coordination for patients with pediatric cancer toward the end-of-life, such as “few home physicians and home health care nurses who could accept terminally ill children” and “a small number of cases and lack of accumulated experience”. Seven categories were identified as efforts of discharge coordination, including “maintaining connections with the community” in three situations: coordination with home physicians and home-visit nursing care, coordination with children and their families, and coordination in hospitals. The number of children who spend their end-of-life days at home is increasing, and we believe that it is necessary to consider expanding the role of pediatric cancer base hospitals in the future, such as collecting information in the community and sharing good practices.

Objective: This study aimed to clarify the preferred place for end-of-life care and the perceptions of palliative care among elderly people living in areas with a high aging rate and limited healthcare resources. Methods: A questionnaire survey was conducted in June 2022, one and a half years after the palliative care team (PCT) was established, in a community with an aging population of over 40%. Results: Among 1,298 patients aged 65 years or older, 475 (36.6%) provided valid responses. Of these, 317 (66.7%) expressed a preference to spend as much time as possible at home for end-of-life care, and 157 (49.5%) indicated that it would be difficult to spend their final days at home. In addition, 277 (58.3%) of respondents had heard about palliative care, and 437 (92.0%) had never heard of PCT at the hospital. Conclusion: Our findings revealed the preferred place for end-of-life care and awareness of palliative care among elderly people living in areas with a highly aging population and limited healthcare resources. It is necessary to promote palliative care in hospitals and develop a collaborative system with community healthcare providers.

Purpose: Owing to the increasing mortality rate in Japan, basic nursing education on the end-of-life care is essential. This study determined the educational learning outcomes of the angel care practice that involves angel makeup based on the reflective descriptions of nursing students. Methods: About 87 students enrolled in the “Seminar in Adult Nursing Practice (Nursing at the End-of-Life: Angel Care)” course at Iwate Medical University School of Nursing in June 2021 consented to participate in the present study. After experiencing the roles of patient, family member, and nurse in the angel care practice, the participants reflected on the care they provided to the patients and their families. Their descriptions on the practice sheets were analyzed to determine the learning outcomes of the angel care practice. Results: “Awareness of the importance of angel care,” “understanding angel care through practice,” and “motivation and concerns as a nurse” were the learning outcomes of the angel care practice for nursing students. Conclusion: The practice that incorporates angel care along with lectures provides nursing students with an opportunity to learn ways to maintain their patient’s dignity.

Introduction: Calciphylaxis is a rare disorder characterized by painful ischemic skin ulcers. There is currently no approved therapy and its pain management is often challenging. Case: A 40-year-old female was diagnosed with calciphylaxis seven years after starting hemodialysis. Despite the administration of sodium thiosulfate intravenous and intralesional combination therapy, the ulcers progressed on both lower limbs and buttocks. She suffered from terrible and opioid refractory pain due to ulcers. After careful consideration of the appropriateness, a lumbar sympathetic ganglion block (LSGB) was performed. Six months later, all the ulcers had re-epithelialized and she was relieved of pain. Conclusion: While the appropriateness of LSGB must be carefully evaluated, it could be a treatment option for patients with central-type calciphylaxis.

Background: Despite the significant physical, emotional, and financial burdens faced by the families of cancer patients, such as caregiving, assisting with hospital visits, and supporting social activities, research on their quality of life (QOL) remains insufficient. Objective: To evaluate the QOL of the families of patients undergoing chemotherapy for cancer and to investigate its relationship with the patients' treatment courses. Methods: A prospective analysis was conducted using EORTC-QLQ-C30 to measure the QOL of patients with unresectable or recurrent solid tumors and their families. Assessments were performed before first-line treatment and before second-line treatment in patients treated at our department between 2016 and 2024. Changes in QOL over the treatment periods and the impact of treatment efficacies were examined. Results: A total of 45 patients were included. Family members frequently reported fatigue, pain, insomnia, and financial difficulties both before and after treatment. Emotional and cognitive functioning declined to the same extent as in patients and did not recover over time. Social functioning notably reduced during the early treatment phase. Treatment efficacy had no impact on the QOL of family members. Discussion: The survey using self-administered questionnaires revealed the consistent need for emotional support for families and highlighted the importance of early social support during the treatment phases.

Introduction: Carotid sinus syndrome is rarely associated with head and neck malignant cancer. We usually have no effective treatment for carotid sinus syndrome in terminal stage of cancer. We experienced a case in which continuous explanation of his condition and lifestyle guidance resulted in alleviation of syncope attacks. Case: A 73-year-old male who was diagnosed with oropharyngeal cancer and with multiple lymph node metastases in the neck. Dizziness and syncope attacks occurred to him due to carotid sinus syndrome. He was referred to the outpatient department of palliative medicine, then he and his wife received explanation of his condition and lifestyle guidance of avoiding triggers and of how to avoid syncope attacks at the onset of prodomal symptoms. The frequency of attacks decreased and he resumed his daily walk. However, attacks without triggers began to occur to him seven months after the intervention started. Although he continued to stay at home, he was hospitalized due to difficulty in body movement and died the next day. Discussion: Explanation of his condition and lifestyle guidance were useful for management of syncope attacks because the syncope attacks had triggers and prodomal symptoms. The interventions including lifestyle guidance improved his quality of life and let him stay at home.

Objective: To investigate an impact of the new coronavirus infection on cancer peer support in hospitals. Methods: A 14-item, self-administered, unannounced questionnaire was administered at the consultation and support centers of Designated Cancer Care Hospitals from February 16, 2023, to March 17, 2023. Results: Of the 451 hospitals, 220 responded (48% response rate). In the aftermath of the COVID-19 pandemic, 89% of hospitals suspended patients support and 36% continued to do so. The following characteristics of the pandemic’s impact were identified: (1) stagnation of peer support, (2) introduction of online support, and (3) the need to develop hybrid support activities and acquire online support response skills. Before the COVID-19 pandemic, the operational structure of peer support was already facing challenges. Conclusion: This study suggests the need to establish an operational system for in-hospital peer support, including the use of the new online system introduced during the COVID-19 pandemic.

Purpose: The purpose of this study was to clinically implement an advance care planning (ACP) program using existing communication tools between patients and healthcare providers, and to clarify the effectiveness of the intervention. Methods: Cancer patients admitted to 2 departments at a local designated cancer hospital, as well as doctors and nurses, were divided into 2 groups: 9 people in the usual care group (control group), and 9 people in the intervention group utilizing the ACP program using an instruction manual, etc. Then, 6 items related to implementation status, and the effect of the ACP program were analyzed. Results: Regarding the implementation of the ACP program, the implementation rate was 42% (T1, 1 month later), 0% (T2), and 33% (T3). The effect of the ACP program was that discussion between healthcare providers and patients and families (P=0.0027) and care aligned with patient goals (P=0.0027) were significantly higher in the intervention group. Conclusion: By presenting specific behavioral indicators as an ACP program, this study served as a trigger for general ACP behavior among both patients and healthcare providers.

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.

Purpose: This study aimed to a geographic accessibility, including patient coverage, of facilities providing specialized palliative care in Hokkaido. Methods: Vital statistics and digitized geographic information were used as data. We estimated the number of patients in need of palliative care, including both cancer and non-cancer patients, based on estimated by Murtagh et al. and the mortality statistics for Hokkaido. We analyzed the coverage rate within a 16 km radius of specialized palliative care facilities, as well as the distances and travel times to these facilities. Results: Cancer patient coverage within the 16 km radius, with hospitals providing specialized palliative care as the main purpose of coverage, was 77.2%. Patient coverage, including noncancer patients, in home-based palliative care facilities was 83.2%. The average time for cancer patients to arrive at the nearest hospital providing specialized palliative care varied from 9.7 to 197.0 minutes, with regional differences. Discussion: We assessed geographic accessibility to specialized palliative care in Hokkaido. In the future, we suggest the need for optimal allocation of medical facilities and collaboration between hospitals and home care to improve equity of specialized palliative care provision.