Masako Kawa

Existential concerns of terminally ill cancer patients receiving specialized palliative care in Japan

BackgroundAlthough alleviation of existential distress is important for terminally ill cancer patients, the concept of existential distress has not been fully understood. The aim of this study was to categorize existential concerns of Japanese terminally ill cancer patients and explore care strategies based on the categorizations.MethodsA multicenter cross-sectional study in 88 terminally ill cancer patients receiving specialized inpatient palliative care was performed. The nurses explored patient existential concerns by asking several key questions, and recorded the answers that they considered typically described the patients’ concerns. All statements recorded by the nurses were analyzed using content analysis methods.ResultsA total of 89 statements were subjected to analysis. The categories and their prevalence were: relationship-related concerns (22%; isolation, concerns about family preparation, conflicts in relationship), loss of control (16%; physical control, cognitive control, control over future), burden on others (4.5%), loss of continuity (10%; loss of role, loss of enjoyable activity, loss of being oneself), uncompleted life task (6.8%), hope/hopelessness (17%), and acceptance/preparation (25%).ConclusionsExistential concerns of Japanese terminally ill cancer patients were categorized as relationship-related concerns, loss of control, burden on others, loss of continuity, uncompleted life task, hope/hopelessness, and acceptance/preparation. These themes seemed to encompass universal human suffering beyond cultural differences, and this conceptualization may contribute to the development of effective therapeutic interventions to alleviate existential distress.

Reliability and validity of the Japanese version of the Support Team Assessment Schedule (STAS-J)

OBJECTIVE The aim of this project was to develop an appropriate and valid instrument for assessment by medical professionals in Japanese palliative care settings. METHODS We developed a Japanese version of the Support Team Assessment Schedule (STAS-J), using a back translation method, and tested its reliability and validity. In the reliability study, 16 nurses and a physician who work in a palliative care unit evaluated 10 hypothetical cases twice at 3-month intervals. For the validity study, external researchers interviewed 50 patients with matignancy and their families and compared the results with ratings by the nurses in the palliative care unit. RESULTS Our results with hypothetical cases were: interrater reliability weighted kappa = 0.53-0.77 and intrarater reliability weighted kappa = 0.64-0.85. In the validity study comparing nurse evaluations and the results of interviews with patients and families, complete agreement was 36-70%, and close agreement (+/-1) was 74-100%. As a whole, weighted kappa were low: between -0.07 and 0.51. Our results were similar to those in the United Kingdom and Canada. SIGNIFICANCE OF RESULTS Although this research was conducted under methodologically limited conditions, we concluded that the STAS-J is a reliable tool and its validity is acceptable. The STAS-J should become a valuable tool, not only for daily clinical use, but also for research.

Difficulties encountered by nurses in the care of terminally ill cancer patients in general hospitals in Japan

The aim of this study was to investigate the difficulties encountered by nurses who have cared for terminally ill cancer patients at general hospitals. To collect data, a survey by questionnaire was self-administered. The respondents were 375 nurses and the response rate was 70.2%. Factor analysis was conducted on 80 items related to the difficulties encountered by nurses who have cared for terminally ill cancer patients to allow reasonable item reduction and to explore better domains. Two items were excluded and the results revealed eight underlying domains: Communication with patients and families, Knowledge and skill of nurses, Treatment and informed consent (IC), Personal issues, Collaboration as a team including patients and families, Environment and system, Collaboration among nurses, and Near-death issues. Cronbachs alpha coefficients for each domain ranged from 0.77 to 0.93. The results showed that nurses working at general hospitals have experienced a high degree of difficulty overall while caring for the dying, particularly with communication with patients and families. It was concluded that this study was useful in determining the specific areas where nursing education and research should be focused.

Effects of an Off-Site Walking Program on Energy Expenditure, Serum Lipids, and Glucose Metabolism in Middle-Aged Women

The present study aims to identify the effects of systematic walking on exercise energy expenditure (EEE) and blood profiles in middle-aged women. Fifty-two female nurse managers, aged 32 to 57 years (42.0 ± 6.2), were randomly assigned to an intervention group (IG) and a control group (CG) for a 12-week study of the walking program. EEE was measured using a microelectronic device. Blood profiles were assessed before and after the walking program. The mean EEE (kcal/kg/d) in the IG and CG was 4.73 ± 1.02 and 3.88 ± 0.81 (P = 0.01), indicating an increase of 1.17 ± 0.98 and 0.46 ± 0.68 from baseline (P = 0.01), respectively. The mean change in high-density lipoprotein cholesterol in the IG and CG was 1.8 ± 8.3 mg/dL and −2.9 ± 7.0 mg/dL (P = 0.051); that in insulin was −4.5 ± 7.5 μU/dL and −0.6 ± 4.3 μU/dL (P = 0.046), respectively. These results show that systematic walking increases EEE and improves blood profiles.

Validity and reliability of the Japanese version of the Caregiver Reaction Assessment Scale (CRA-J) for community-dwelling cancer patients.

Background: The aim of this study was to validate the Caregiver Reaction Assessment (CRA) among caregivers of community-dwelling advanced cancer patients in Japan. Methods: A cross-sectional questionnaire was administered to advanced cancer patients and their caregivers who were cared for at day hospices and home palliative care services. We translated the CRA into Japanese, and then verified factor validity, reliability, construct validity, concurrent validity, and known groups’ validity. To address construct and concurrent validity, we calculated Pearson’s correlation coefficient between the Japanese version of the CRA and the Burden Index of Caregivers (BIC). To address known groups’ validity, we used the t test or analysis of variance (ANOVA). Results: A total of 57 caregivers participated in the study. Five factors were extracted (‘‘impact on schedule,’’ ‘‘caregiver’s self-esteem,’’ ‘‘lack of family support,’’ ‘‘impact on health,’’ and ‘‘impact on finances’’) and reliability was good. Construct and concurrent validity among the subscales of the BIC were good. Regarding known groups validity, the subscale score of ‘‘impact on schedule’’ for the groups that cared 6 hours or more per day was higher than the other group (P = .04). Conclusion: The CRA-J is valid and reliable. This scale is useful for caregivers of cancer patients in Japan.

Quality of Life, Day Hospice Needs, and Satisfaction of Community-Dwelling Patients with Advanced Cancer and their Caregivers in Japan

BACKGROUND The aims of this study were to clarify (1) the quality of life (QOL) of community-dwelling patients with advanced cancer and their caregivers in home palliative care and day hospice settings, (2) the need for day hospice of home palliative care patients and caregivers, and (3) the satisfaction with day hospice by day hospice patients and caregivers. METHODS A cross-sectional questionnaire was administered to patients with advanced cancer and their caregivers who were cared for at day hospice and home palliative care. We measured the health-related quality of life using the SF-8, the need for day hospice of home palliative care patients and caregivers, and the satisfaction with day hospice by day hospice patients and caregivers. RESULTS A total of 57 pairs of patients and caregivers participated in the study (day hospice, n = 23; home palliative care, n = 34). The physical and mental aspects of the patient QOL were significantly lower than national standard value. However, although physical aspect of caregivers QOL was significantly lower than national standard value, mental aspect of caregivers QOL was not lower than national standard value. Forty-four percent of home palliative care patients and 67% of home palliative care caregivers preferred day hospice. The needs of patients and caregivers were wide ranging including medical treatment, distraction, information provision, and respite. Overall, the Japanese day hospice was evaluated highly. CONCLUSION This is the first study of day hospice in Japan. Although there are several day hospices in Japan, the initiation of day hospice would probably be successful. The dissemination of day hospice is an important issue for patients with advanced cancer and their caregivers in Japan.

Discharge from a palliative care unit: prevalence and related factors from a retrospective study in Japan.

PURPOSE Selecting a place for end-of-life care is an important issue for patients with cancer. In this study we conducted a retrospective analysis on the prevalence of discharge from a palliative care unit (PCU) and explored factors related to discharge based on individual-level data from 5 years of experience at the Tokyo Metropolitan Toshima Hospital PCU. METHODS We retrospectively collected information on patients and families from the admission database of the PCU. We calculated the prevalence of patients discharged from the PCU and explored the factors related to discharge using bivariate and multivariate analysis. RESULTS The subjects were 498 terminal patients with cancer. The overall discharge rate was 33%. For subjects who were admitted for symptom control, the discharge rate was 54%. The duration of the period from referral to death (odds ratio [OR] = 4.98, p < 0.001), Eastern Cooperative Oncology Group Performance States [ECOG PS]_OR = 0.51, p = 0.003), problems with oral intake (OR = 0.41, p = 0048), presence of nausea (OR = 0.41, p = 0.046), experience of radiation therapy (OR = 0.27, p = 0.003), and patients anxiety for family (OR = 0.35, p = 0.029) were independent related factors for discharge from the PCU, according to logistic regression. CONCLUSION Early referral to the PCU and development of alleviation methods for symptoms such as nausea and anxiety and depression are important for promoting discharge and would contribute to the patients quality of life at the end of life.

The current status of palliative care teams in Japanese university hospitals: a nationwide questionnaire survey.

GoalAlthough the importance of the palliative care team (PCT) to university hospitals is widely accepted, the issues of palliative care at the national level have not been clarified. We conducted a nationwide survey of the current status of PCTs in all (123) Japanese university hospitals.Materials and methodsIn 2003, 2004 and 2005, the authors conducted a self-reporting cross-sectional survey. Questionnaires were mailed to nursing directors and selected PCT members of all Japanese university hospitals.ResultsOf 123 hospitals in 2005, 99 (80%) returned the questionnaire; 33% used PCTs, and 11% used certified PCTs. Our findings include: annual number of patients treated by PCTs (83/70 ± 64, mean/median ± SD), daily number of patients treated by PCTs (12/11 ± 14), and days of PCT care per patient (30/30 ± 22). Certified PCTs treated more patients per year (p = 0.004) and more patients per day (p < 0.001) compared to noncertified PCTs. Over the 3-year period, the number of hospitals utilizing PCTs only slightly increased (2003: 27%, 2004: 29%, 2005: 33%), as did those using certified PCTs (2003: 3%, 2004: 9%, 2005:11%). In 2005, the reasons for noncertification of PCTs included “lack of physicians who specialize in palliative care (82%)” and “lack of nurses who specialize in palliative care (56%).”ConclusionsThe entire system of palliative care in Japanese university hospitals is currently insufficient. The lack of physicians and nurses who specialize in palliative care is a significant barrier, and therefore, the initiation of a formal training system for these health care professionals is a high priority issue.

Pain management and related factors in advanced cancer patients who initiated opioid therapy in an outpatient setting.

OBJECTIVE The aim of this study was to clarify the state of pain management in Japanese patients with advanced cancer who initiated opioid therapy in an outpatient setting. METHODS Interview surveys using questionnaires were conducted and medical records were reviewed. Pain relief was defined as >33% decrease in worst pain intensity score, and significance of early pain relief was investigated in terms of changing self-efficacy for activities of daily living (ADL). Factors related to early pain relief were also investigated. RESULTS The study was conducted between June and December 2003, on 20 patients (13 women, 7 men; mean age, 59 years). Compared to score at initiation of opioid administration (Numerical Rating Scale, 8.3 +/- 1.3), pain relief was generally insufficient at 2 weeks (early pain relief ratio was only 42%). Patients with sufficient pain relief at 2 weeks displayed significant improvements in numerous ADL functions and symptom-coping efficacy (p = 0.037), confirming the importance of early pain relief. Early pain relief was associated with high frequency of hospital visits before opioid administration and absence of sudden excavation within the first 2 weeks. SIGNIFICANCE OF RESULTS Result of this study indicated insufficient pain relief at an outpatients setting with advanced cancer patients. In the meantime, patients had who their pain decrease after 2 weeks also had improved ADL and self-efficacy at the same time. These findings suggest that to achieve early pain relief in an outpatient setting, clinical staff must assess pain earlier and inform patients of possible breakthrough pain following opioid administration and available treatments for such occurrences.

Empowering Nurses Through Translating the End-of-Life Nursing Education Consortium: The End-of-Life Nursing Education Consortium-Japan Core Curriculum Project

The End-of-Life Nursing Education Consortium–Core Curriculum was translated in 2005 and has made a significant contribution to Japanese nurses. In this article, we describe our experience with curriculum revision to reflect on the cultural background inherent in Japan and evaluate the effect that it brought to the trainers. The main focus of this major revision was to (1) make the content relevant to the Japanese health care system, (2) add unique cultural considerations to each module, (3) replace case studies and role play scenarios, (4) add a new module “End-of-Life Care for Geriatric,” and (5) set clear rules for trainers. One thousand one hundred twenty evaluations were collected from participants of the End-of-Life Nursing Education Consortium–Japan Core train-the-trainer programs from 2011 to 2016. Course evaluations were highly positive, with all questions having mean scores greater than 4.1 of 5 across all 6 years of study. Comparative statistical analysis showed that refinement of the course not only helped nursing educators gain knowledge but also assisted them with developing a clear picture of how to plan and organize their training course. This course could be a valuable model to nursing educators seeking to develop their own leadership training seminar or introducing End-of-Life Nursing Education Consortium curricula.