Development of a Patient Registry System for Specialized Palliative Care Quality Assessment Using Patient-reported Outcomes: A Multicenter Pilot Study

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.

Multi-center Study to Assess the Feasibility of the Self-Check Program for Palliative Care Team

Introduction: Number of palliative care team increase every year, but the quality of team might differ from each other. We developed “Self-Check Program for Palliative Care Team” to assess and improve the quality of palliative care team. We report the result of the multi-center study to assess the feasibility of this program. Methods: We underwent the “Self-Check Program” as a trial at seven hospitals in Japan in February 2016. We took a questionnaire survey to team leaders and participants to assess the feasibility of this program. Results: Fifty-two medical staffs in six hospitals accomplished this program. Time scheduling and the integration of opinions from each team members were the difficulties came up from questionnaire survey. All team leaders and 87.8% of the participants answered that this program was effective to extract and improve the problem of the team. Also 83.3% of the team leaders were satisfied with the process of planning. Conclusion: Despite some difficulties, majority of the participants considering useful, this program is considered feasible.

Three Cases of Terminal-stage Ovarian Cancer in Which Diatrizoate Meglumine and Diatrizoate Sodium Solution (Gastrografin) Treatment for Gastrointestinal Symptoms of Malignant Bowel Obstruction Was Effective

<p>We report three cases of terminal-stage ovarian cancer where diatrizoate meglumine and diatrizoate sodium solution (Gastrografin) was effective for malignant bowel obstruction due to peritoneal dissemination. All cases had gastrointestinal symptoms such as nausea, vomiting, abdominal pain, and constipation, showed air-fluid levels and dilation of the small intestine on imaging tests. Therefore, all the cases were diagnosed as bowel obstruction. We initiated oral administration of Gastrografin because the patients failed to show a sufficient response to other drugs such as octreotide. Their gastrointestinal symptoms such as nausea and constipation improved after administration of the drug, and they could continue oral intake. In addition, they were diagnosed as having an incomplete bowel obstruction since radiographic examination 24 hours after administration of Gastrografin confirmed its presence in the large intestine. In all the cases, Gastrografin could be used repeatedly without noticeable side effects. This study suggests that Gastrografin might be useful for evaluating bowel obstruction and improving gastrointestinal symptoms in patients with malignant bowel obstruction caused by terminal-stage ovarian cancer.</p>

Prolonged hyperglycemia after intraperitoneal administration of triamcinolone acetonide in an end-stage ovarian cancer patient with refractory ascites

<b>Case</b>: A 71-year-old woman with diabetes mellitus was diagnosed as end-stage ovarian cancer. She was suffering from stomachache and anorexia because of massive ascites. Although we performed abdominal paracentesis for symptomatic palliation, ascites accumulated again in a few days. In order to control the refractory ascites, we administered intraperitoneal triamcinolone acetonide (10 mg/kg) after the fourth abdominal paracentesis; consequently, the interval between the consecutive abdominal paracentesis procedures was extended remarkably. However, prolonged hyperglycemia occurred despite the administration of a single dose of triamcinolone acetonide, and insulin therapy was required for eight days. <b>Conclusion</b>: To our knowledge, this is the first report of intraperitoneal administration of triamcinolone acetonide that caused prolonged hyperglycemia. Therefore, this drug should be administered with caution in such patients with diabetes mellitus.