Public Prognosis Explanations, End-of-life Care, Decision-maker Hopes, and Related Factors

Purpose: This study clarified the general public’s end-of-life decision-making expectations and related factors. Method: We analyzed secondary data of 1,000 adults surveyed through the Internet. The outcome was to determine the life expectancy at the end of life, end-of-life care, and decision-makers’ wishes. Results: Regarding the prognosis, 54% wanted to know the life expectancy in end-of-life. This preference was independently associated with being notified of cancer at a young age, trust in medical professionals, and the view of life and death that disappears. Regarding end-of-life care preferences, 11% requested active treatment, and 58% requested palliative care. This preference was independently associated with older age, women, and an emphasis on being pain-free and being yourself. Regarding decision-makers’ preferences, 77% wanted to decide for themselves, and 11% wanted to decide for their families. This preference was independently associated with the young, carefree of life and death, who did not want to be notified of cancer. Conclusion: We revealed the general public’s desire for end-of-life decision-making and associated factors. In clinical practice, it can be used for screening.

Nurses’ Experience in the Introduction of Palliative Sedation for Patients with Terminal Lung Cancer in Respiratory Medicine Wards

Palliative sedation (PS) is an effective way to alleviate the refractory symptom of terminally ill cancer patients, however it can be ethical. PS is now being implemented in general wards, and there is an urgent need to understand the actual conditions of sedation care for general ward nurses and improve the quality of care. In this study, a semi-structured interview was conducted with nurses working in a respiratory medicine ward of a core cancer treatment hospital. By Krippendorff’s content analysis, 16 categories of nurses’ actions/judgments, 8 categories of positive thoughts, and 5 categories of negative thoughts were extracted. Nurses have always sought the best way to alleviate the pain of patients and their families, and have endeavored to be close to their feelings. However, there was a difference in confidence and positivity regarding multidisciplinary collaboration and sedation discussions. It was suggested that the confident efforts of nurses may support the decision-making of patients and their families and consider methods for pain relief and QOL.

Factors Related to Gemcitabine-induced Phlebitis

Objective: The purpose of this study was to clarify the factors related to gemcitabine (GEM)-induced phlebitis. Methods: We retrospectively analyzed 400 cases of intravenous GEM administration to 50 patients from June 2014 to May 2015. We assessed the relationship between GEM-induced phlebitis and various factors including age, sex, BMI, analgesic use (NSAIDs or opioids), and GEM-administration procedures including drug formulation, dosage, and access site. Results: Phlebitis occurred in 79 cases (19.8%). Multivariate analysis indicated that sex (female), age (<65 years old), BMI (≥25 kg/m2; obesity), drug formulation (liquid), and access site (dorsal hand vein) were significantly related to the presence of phlebitis. Discussion: GEM-administration procedures should be modified in patients with these risk factors. It is desirable to apply hot fomentation and to puncture at the brachial region or cubital fossae region vein to prevent phlebitis.

Usefulness of“Tablet PC application for Pain Memory”on cancer pain assessment

<b>Objective：</b>The previous study was to develop the“Itamikei”, a small machine which patients can use to record their subjective level of pain. And new assessment tool“Tablet PC application for Pain Memory”, which enable the user to visualize and record the pain levels both instantly and over time. The purpose of this study was to examine the effectiveness of Pain Memory as a pain assessment tool for patients with cancer pain. <b>Method：</b>12 inpatients prescribed analgesics for cancer pain, were instructed to input their pain level into Pain Memory over a 2-week period, and the resulting graph was reviewed by the patient and staff. They also completed a questionnaire evaluating the design, function and pain assessment of the tool. <b>Result：</b>The patients input their pain level into Pain Memory 5.25 times／day（Md）, which provided increased opportunities to ascertain the patient’s pain level compared to that“Itamikei”. The design and function of the Pain Memory were given approximately rate 4 using a 5 point scale by both patients and staff members. Moreover, using Pain Memory, the patients highly rated the parameter“I understood changes in pain”, and the staff members highly rated the parameter“Patients participating in the treatment of pain”.<b> Conclusion：</b>We found Pain Memory could be useful in the assessment of pain. It provided more opportunities to ascertain the pain level of patients, and enabled the visualization of the pain level through a graph.

Experiences of cancer survivors who use a palliative day care salon on a university campus

<b>Objectives</b>: The purpose of this qualitative study was to examine the experiences of cancer survivors who used a palliative day care salon on a university campus. <b>Method</b>: Semi-structured interviews were conducted with ten cancer survivors; thereafter, we performed content analysis. <b>Results</b>: Ten categories were identified. The following were identified as motives to participate in the activities of the salon: (1) need for spiritual support, (2) desire to discover the meaning of life. The following experiences were described regarding the salon: (3) a place to express emotions openly, (4) a place to engage in activities as one pleases, (5) a place to communicate with others and express one’s true feelings, (6) a place that instills vigor as a result of expert advice. The following changes were identified after participation: (7) adopting an appropriate lifestyle, (8) improvement in image during the recurrence of cancer and towards the end of one’s life, (9) better family and social relationships, (10) a broader range of activities and uplifted sense for playing their roles. <b>Discussion</b>: Cancer survivors require support. In the salon, they could openly express their true feelings about their experiences of cancer and readily accepted one another. Further, their perceptions and attitudes toward life were being transformed through an enhanced sense of self-awareness. This transformation was facilitated by free activities on the university campus, an assurance of physical and psychological safety, and an indication of an outlet for such transformation.

Effects of the Pain Level Memory Device on cancer pain management

<b>Objective</b>: The Pain Level Memory Device (PLMD) is an instrument which patients can use to record their subjective level of pain. The usefulness of the PLMD on both medical staffs in managing cancer pain and the independence of patients were examined in this study. <b>Method</b>: Ten participants, inpatients at Nagoya University Hospital prescribed opioid drugs for cancer pain, were selected and asked to input any change in their pain level into the PLMD for a 14 day period between February and April 2005. A graph of the resulting data was printed and given to both the patient and medical staffs. And a questionnaire evaluating their experience with the PLMD was developed and administered to both. Relationships between the frequency of use of the PLMD and item-scores on the questionnaire were investigated. <b>Results</b>: The median number of inputs into the PLMD was 4.5 (range: 0.5-11) per day. High usage of the PLMD and each high score for the questionnaire items "The PLMD helped assessment of pain (p<.05)" and "The patients satisfaction with pain control improved (p<.05)" were strongly correlated. Spearman's rank correlation coefficient showed a relationship between the median number of inputs and the questionnaire items, "I used the PLMD whenever I intended to (r=.80, p<.01)", ""I saw graphs (r=.78, p<.01)", "I discussed graphs with my doctor (r=.70, p<.05)", "I felt that I participated in my pain management (r=.82, p<.01)", and "I would recommend the PLMD to other patients (r=.80, p<.01)". <b>Conclusion</b>: These results suggested that the PLMD could assist medical staff in the control of cancer pain and support the independence of patients.

Trial test of the "Itamikei", a pain meter and its ease of operation for clinical practice

The purpose of this study was to develop the "Itamikei", a small machine which records the subjective level of pain between 0-10. In addition to testing it's ease of operation and usefulness in the clinical practice environment. The "Itamikei" is 23 cm x 6 cm x 2 cm. It weighs 160 grams. It has 11 buttons, relating to the 0-10 Numeric Rating Scale (NRS). Each time a button is pushed the level of pain is recorded, along with the time and date. Later, this data can be transferred to computer displayed graphically showing the patient's subjective level of pain. This research was a case study for using the "Itamikei". One in-patient at the university hospital who had cancer pain was asked to use the "Itamikei" for 14 days. A graph was printed out and given to both the patient and the medical staff. <BR>The results suggest the following: <BR>1. Using the 0-10 NRS the patient could easily express her level of pain. <BR>2. Because the "Itamikei" was easy to operate, the patient found no difficulty in entering her level of pain. <BR>3. In graph form the daily transition in pain levels can be easily analyzed, and a program for managing pain can be prepare.