ABSTRACT
Background: Consideration of cultural aspects is important in medical care. We explored regional differences in cancer and palliative care among Okinawa, Tohoku, and Tokyo metropolitan area. Methods: We conducted a questionnaire survey of physicians involved in cancer medicine from September to November 2020. A total of 11 items related to physician experiences were rated using a 5-point Likert-type scale. Results: Responses were received from 553 physicians (187 in Okinawa, 219 in Tohoku, 147 in the Tokyo metropolitan area). In Okinawa, “When patients die, it is important that all family members are present at the last moment,” “Patients/family members primarily consult the elders of the family about the medical treatments,” “Family members hope the patients die at home, because the soul will not return when they die at the hospital,” “Patients/family members get advice from religious advisors about the medical treatments,” and “Family members wish to take the patient home when he/she is about to die and to confirm death at home” were significantly more frequently observed. In Tohoku, “Patients wish to be hospitalized at a specific season” was significantly more frequently reported. In Tohoku and Okinawa, “Patients hide cancer from neighbors and relatives” and “Elderly patients do not want treatment, because they cover the living expenses and education expenses for their children and grandchildren.” were significantly more frequently experienced. Conclusion: There are regional differences in cancer and palliative care in Japan. Being sensitive to the culture of the region is needed.
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<p>Aim: To clarify the predictive risk factors for bedsores of terminal cancer patients receiving home-based care. Methods: A retrospective study was conducted involving 95 terminal cancer patients receiving home-based care, including people using services provided by home-visit care providers until death. Results: The numbers of patients with and without bedsores were 31 and 64, respectively. Bivariate analyses revealed that significant variables were the Ohura-Hotta scale (P=0.02), hyperactive delirium (P=0.005), contracture (P=0.008), and anemia (P=0.02). According to multivariable logistic analysis, significant variables were contracture (OR=16.55, P=0.0002) and hyperactive delirium (OR=4.22, P=0.008) as independent risk factors for bedsores. Discussion: For terminal cancer patients receiving home-based care, hyperactive delirium should also be considered as a predictive risk factor for bedsores.</p>
ABSTRACT
<b>Purpose</b>: The aim of this study was to evaluate the influence of informing patients of the endpoints of palliative chemotherapy on the quality of care for terminally ill cancer patients. <b>Methods</b>: Of 85 advanced cancer patients who died at our hospital during the last 2 years, 53 patients who received palliative chemotherapy were recruited for this study. The patients were divided into three groups based on whether disease status and treatment endpoints were explained to the patient before the chemotherapy: group A; both the disease status and treatment endpoint were explained, group B; only the disease status was explained, and group C; neither were explained.Japanese version of Support Team Assessment Schedule (STAS-J) was used to evaluate the quality of care for the patients. <b>Results</b>: Of the 53 patients, 17, 22, and 14 cases were assigned to group A, group B, and group C, respectively. Changing gear, that is, stopping palliative chemotherapy followed by palliative care, was well accepted by 88%, 41%, and 0% of group A, B, and C patients, respectively (p<0.01). By using the STAS-J, it was revealed that there were no significant differences in either symptom control or in anxiety among the groups, but there were significant differences in insight of advanced disease and communication to others (p<0.001). <b>Conclusion</b>: When performing palliative chemotherapy in advanced cancer patients, they should be informed of its endpoint before beginning the chemotherapy. This will lead to successful ′changing gear, ′ and improvement of the quality of care for terminally ill cancer patients.