Sakiko Fukui

Determinants of the place of death among terminally ill cancer patients under home hospice care in Japan

Although the place of death of patients with terminal cancer is influenced by multiple factors, few studies have systematically investigated its determinants. The purpose of this study was to examine the influence of the patientsflsociodemographic, clinical and support network variables on the place of death of terminally ill cancer patients under the care of home care agencies in Japan. Among 528 patients from 259 home care agencies, 342 (65%) died at home and 186 (35%) died at a hospital. From the multivariate logistic regression model, patients who expressed the desire for receiving home care at referral [odds ratio (OR), 95% confidence interval (CI): 2.19, 1.09-4.40] in addition to the family caregivers desire for the same (OR, 95%CI: 3.19, 1.75-5.81), who had more than one family caregiver (OR, 95%CI: 2.28, 1.05-4.94), who had the support of their family physician (OR, 95%CI: 2.23, 1.21-4.08), who were never rehospitalized (OR, 95%CI: 0.04, 0.02-0.07), who received more home visits by the home hospice nurse during the stable phase under home hospice care (OR, 95%CI: 1.25, 1.02-1.53), and who were in the greatest functionally dependent status during the last week prior to death (OR, 95%CI: 8.60, 4.97-14.89) were more likely to die at home. Overall, this model could accurately classify 95% of the places of death, which is higher than other published studies. A clearer understanding of factors that might influence the place of death of terminally ill cancer patients would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die at their place of preference.

The effect of a psychosocial group intervention on loneliness and social support for Japanese women with primary breast cancer.

PURPOSE/OBJECTIVES To examine the effects of a psychosocial group intervention on loneliness and social support in Japanese women with breast cancer. DESIGN Secondary analysis of a randomized, controlled trial. SETTING A breast cancer outpatient area of a National Cancer Center hospital in Japan. SAMPLE 50 women who were less than 65 years old, were diagnosed with primary breast cancer, and had undergone surgery within 4-18 months of the start of the study. METHODS Data were collected as part of a trial of an intervention. The investigators conducted a six-week group intervention consisting of health education, coping skills training, stress management, and psychological support. Subjects completed the revised University of California, Los Angeles, Loneliness Scale and a social support questionnaire at baseline, six weeks, and six months. MAIN RESEARCH VARIABLES Loneliness, number of confidants, satisfaction with confidants, and satisfaction with mutual aid. FINDINGS Fifty (33%) of the 151 invited patients participated and were randomized to either experimental (n = 25) or control (n = 25) groups, and 23 (92%) in each group completed the study. The experimental group had significantly lower scores than the control group for loneliness and significantly higher scores for the number of confidants, satisfaction with confidants, and satisfaction with mutual aid over the six-month study period. CONCLUSIONS This intervention is beneficial for Japanese patients with breast cancer experiencing loneliness and inadequate social support. IMPLICATIONS FOR NURSING The program can be used as an effective support for Japanese patients with cancer to manage their psychosocial concerns associated with illness.

Late referrals to home palliative care service affecting death at home in advanced cancer patients in Japan: a nationwide survey

BACKGROUND To identify factors influencing place of death among home palliative care patients with advanced cancer, focusing on the timing of referrals from hospital to home care settings. METHODS A cross-sectional nationwide questionnaire survey was conducted on home palliative care patients at 1000 randomly selected home care agencies in Japan. A total of 568 responses were analyzed (effective response rate, 69%). RESULTS Multivariate logistic regression analysis revealed that (i) predischarge health care supports in hospital (e.g. early referral 8 days or more before discharge; clear explanation by hospital staffs to patients and families regarding discharge to live and die at home) and (ii) postdischarge health care supports after transferring home care (e.g. signing a 24-h support insurance contract of network between primary physician and nurse as a home palliative care team; primary nurse consultation with primary physician >3 times during the first week after discharge) have an effect on place of death among home palliative care patients. CONCLUSION An early and carefully coordinated referral support system for smooth discharge by hospital staffs as well as intensive and highly qualified support just after discharge by the home care team would help to increase the number of patients who could die at home.

Effect of communication skills training on nurses' detection of patients' distress and related factors after cancer diagnosis: a randomized study.

Background: A randomized study was performed to investigate whether a communication skill (CS) training program can improve nurses ability to detect the distress of patients who have just been informed of cancer diagnosis.

Relationship between radiographic changes and symptoms or physical examination findings in subjects with symptomatic medial knee osteoarthritis: a three-year prospective study

BackgroundAlthough osteoarthritis (OA) of the knee joints is the most common and debilitating joint disease in developed countries, the factors that determine the severity of symptoms are not yet understood well. Subjects with symptomatic medial knee OA were followed up prospectively to explore the relationship between radiographic changes and symptoms or physical examination findings.MethodsOne-hundred six OA knees in 68 subjects (mean age 71.1 years; 85% women) were followed up at 6-month intervals over 36 months. At each visit, knee radiographs were obtained, symptoms were assessed by a validated questionnaire, and the result of physical examination was recorded systematically using a specific chart. Correlations between the change of radiographs and clinical data were investigated in a longitudinal manner.ResultsDuring the study period, the narrowing of joint space width (JSW) was observed in 34 joints (32%). Although those knees were clinically or radiographically indistinguishable at baseline from those without JSW narrowing, differences became apparent at later visits during the follow-up. The subjects with knees that underwent JSW narrowing had severer symptoms, and the symptoms tended to be worse for those with higher rates of narrowing. A significant correlation was not found between the severity of symptoms and the growth of osteophytes. For the knees that did not undergo radiographic progression, the range of motion improved during the follow-up period, possibly due to the reduction of knee pain. Such improvement was not observed with the knees that underwent JSW narrowing or osteophyte growth.ConclusionThe result of this study indicates that the symptoms of knee OA patients tend to be worse when JSW narrowing is underway. This finding may explain, at least partly, a known dissociation between the radiographic stage of OA and the severity of symptoms.

Effectiveness of communication skills training of nurses on the quality of life and satisfaction with healthcare professionals among newly diagnosed cancer patients: a preliminary study

Introduction: The importance of effective communication skills to sustain the cancer patient quality of life (QOL) and their satisfaction with healthcare professionals is well documented. This study aims to assess the effectiveness of communication skills training (CST) of nurses for patient QOL and their satisfaction with healthcare professionals just after being diagnosed with cancer.

Determinants of financial performance of home-visit nursing agencies in Japan.

BackgroundJapan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies.MethodsWe performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition).ResultsAmong the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation.ConclusionsThe results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations.

Development of a Clinical Tool to Predict Home Death of a Discharged Cancer Patient in Japan: a Case-Control Study

PurposeThe aim of this study was to investigate the predictive value of a clinical tool to predict whether discharged cancer patients die at home, comparing groups of case who died at home and control who died in hospitals or other facilities.MethodWe conducted a nationwide case-control study to identify the determinants of home death for a discharged cancer patient. We randomly selected nurses in charge of 2000 home-visit nursing agencies from all 5813 agencies in Japan by referring to the nationwide databases in January 2013. The nurses were asked to report variables of their patients’ place of death, patients’ and caregivers’ clinical statuses, and their preferences for home death. We used logistic regression analysis and developed a clinical tool to accurately predict it and investigated their predictive values.ResultsWe identified 466 case and 478 control patients. Five predictive variables of home death were obtained: patients’ and caregivers’ preferences for home death [OR (95% CI) 2.66 (1.99–3.55)], availability of visiting physicians [2.13 (1.67–2.70)], 24-h contact between physicians and nurses [1.68 (1.30–2.18)], caregivers’ experiences of deathwatch at home [1.41 (1.13–1.75)], and patients’ insights as to their own prognosis [1.23 (1.02–1.50)]. We calculated the scores predicting home death for each variable (range 6–28). When using a cutoff point of 16, home death was predicted with a sensitivity of 0.72 and a specificity of 0.81 with the Harrell’s c-statistic of 0.84.ConclusionThis simple clinical tool for healthcare professionals can help predict whether a discharged patient is likely to die at home.

Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care

To define the team types consisting of doctors, home‐visiting nurses and care managers for end‐of‐life care by measuring the collaboration relationship, and to identify the factors related to the team types.

Survey on the use of health consultation services provided in a Japanese urban public housing area with a high elderly population.

The aim of the present study was to determine how the elderly in an urban public housing area intends to utilize health consultation services.