Intervention and Implementation Studies on Integrated Care Pathway for End-of-Life Care in Long-term Care Facilities: A Scoping Review

Purpose: Integrated care pathway (ICP) is structured multidisciplinary care plan that aim to improve the quality of care. ICP could be effective in providing quality End-of-Life (EOL) care in long-term care facilities (LTCFs). However, the outcomes and components of ICP for EOL care in LTCFs are not clear. Methods: We conducted a scoping review to identify the outcomes and components. We searched electronic databases (PubMed, CINAHL, Cochrane Library, PsycINFO, Ichushi) and conducted an additional hand search for relevant journal articles related to EOL care. We searched intervention and implementation studies for ICP in EOL care in LTCFs. Results: Thirteen papers met the inclusion criteria. We identified the following components of ICP: documents, education regarding EOL care and ICP, support by experts, and regular conferences among care providers. The effects of ICP were reported as reductions in transfers to hospitals and improvement in staff confidence regarding EOL care. Conclusion: With reference to the components of ICP identified in this study, ICP should be developed based on the characteristics of LTCFs, and the effects of intervention or implementation studies using a more robust design should be examined.

Development of the Japanese Version Bereavement Risk Assessment Tool: A Pilot Survey for Family Members of Cancer Patients

<p>Objective: To develop and to examine the feasibility of the Japanese version Bereavement Risk Assessment Tool (BRAT-J). Methods: Pilot survey was performed at three palliative care units and one home care clinic. Medical staff performed an assessment by using the Japanese version of BRAT (BRAT-J) to examine bereavement risk among families of cancer patients. Results: 25 individuals who had a cancer patient in their family participated in this survey. Of those 25 participants, 7 (28%) were classified as minimal risk, 8 (32%) were low risk, 9 (36%) were moderate risk and 1 (4 %) was high risk. Chi-square was used to test the association between risk level and each items of BRAT. Two items of BRAT, ‘heightened emotional states (anger, guilt, anxiety) as typical response to stressors’ and ‘lack of social support/social isolation (perceived or real)’ were significantly associated with the family member’s risk level. Conclusion: This was a pilot survey to examine the feasibility of BRAT-J in practice. Further qualitative investigation needs to be conducted to determine the appropriate support required for each risk level among the bereaved individuals.</p>

Quality Evaluation and Improvement for End-of-life Care toward Residents in Long Term Care Facilities in Japan: A Literature Review

Long-term care facilities have important roles providing end-of-life-care in Japan. The purpose of this literature review was to examine the current research trend regarding quality evaluation and improvement for end-of-life-care in Japanese long-term care facilities. From a search of key medical databases, potential articles regarding end of life at long-term care facilities were retrieved. We classified retrieved 23 literatures into four research types; four intervention studies, three surveys for development educational / quality improvement tool, thirteen cross-sectional surveys, three qualitative studies. Despite the current increment of the literatures, intervention studies were a few. Related factors of the death in the facilities included administrators’ policy regarding end of life care, and collaboration with the medical institutions, and clear family decision making regarding end of life care. Some research indicated that staffs in long-term care facilities felt difficulty in collaborating with medical institutions, conducting interdisciplinary work, and confirming residents’ intention regarding end-of-life. The results indicate that conducting quality intervention study, supporting administrators of long-term care facilities, promoting residents and family decision making and education for the staffs in long-term care facilities might be effective to improve quality of end-of-life care in long-term care facilities.

Personal growth and related factors among family primary caregivers after bereavement of a terminally ill cancer patient at home

<b>Purpose:</b> To identify the nature of personal growth of family primary caregivers after bereavement and to explore the association between such growth and the experience of caring for a terminally ill cancer patient at home. <b>Methods:</b> A self-administered questionnaire survey was mailed to 112 bereaved family primary caregivers who, with assistance from a palliative care service, had cared for a terminally ill cancer patient at home. The main outcomes were measured using the After Bereavement Growth Inventory, previously developed. <b>Results:</b> Responses from 73 questionnaires were analyzed (effective response rate, 66%). The post-bereavement growth score was significantly higher among the study group than among the general population who had experienced bereavement due to illness-related death. Multiple regression analysis revealed that post-bereavement growth was more likely to occur among those family members who, "at the time they chose to provide home palliative care, intended to care for a patient at home until the time of death" and when "the patient desired home palliative care", those who "felt a deepening of their bond with the patient", and those who "felt the death was peaceful". <b>Conclusion:</b> Our findings suggest that for primary family caregiver's to experience personal growth after bereavement, medical professionals should support patients' preference of place at the end of life and caregivers' preparation for the expected home death, respect the family's bond with the patient, and through appropriate symptom management in home palliative care to maintain the patient's sense of peacefulness until the end of life.

Nursing care for children when a parent is terminally ill

<b>Purpose</b>: Death of a parent is a painful and sorrowful experience for children. The purpose of this study was to describe the nursing care provided to children who had a parent at the end of life. <b>Methods</b>: Data were collected through semi-structured interviews from 11 nurses working for a palliative care unit. <b>Results</b>: Emerging from the qualitative data analysis were five categories: gathering information about the children; laying the foundations for providing care for children; coordination for enabling children and parent to spend time together; explaining to children about the parent's situation and parent's care and participating in an interdisciplinary approach. <b>Conclusion</b>: Further research is needed to identify other staff roles and family needs and perspectives to provide appropriate care for children with a parent who is terminally ill.

Necessity of pain management education for cancer patients' families: a literatures

To enhance the quality of life for cancer patients, it is required that choice and useage of appropriate medications for their symptoms, as well as providing education for patients and their family members be provided. The purpose of this article was to examine the effectiveness of cancer pain management education through a literature review. From a search of key medical databases, potential articles regarding cancer pain management were retrieved. From a thorough literatures review, we found six important trends: (1) discordance of cancer patients and their families pain reports; (2) family perception regarding cancer pain; (3) family's concerns about cancer pain management; (4) family member's role in cancer pain management; (5) helpful resources about cancer pain management and (6) educational programs for cancer patient's family. Further research regarding educational programs for family members is required for improving cancer pain management.