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Purpose: This study was performed to compare the characteristics of home palliative care for elderly patients with cancer between age groups. Methods: The clinical records of 1,032 patients with cancer who received home medical care from June to November 2013 were reviewed retrospectively. Patients were classified as non-elderly (<65 years old), young-old (65-74 years), old-old (75-84 years), or oldest-old (≥85 years), and these groups were compared with respect to demographic characteristics, patient/family problems, outcomes, and medical care and services provided. Results: There was a higher percentage of patients with no caregiver in the oldest-old group than in the other groups (18%, p=0.014), while the young-old and oldest-old groups had a higher percentage of problems related to caregiving such as caregiver burden or absence of a caregiver (32% and 33%, p=0.002, respectively). In addition, the percentage of patients who required visiting nurses and care was higher in the old-old group (86% and 30%, respectively) and oldest-old group (89% and 35%, respectively) compared with the other two groups. Conclusion: Problems related to caregiving, such as caregiver burden or absence of a caregiver, were greater in the old-old and oldest-old groups, and a higher percentage of patients required visiting nurses and care in those two groups.
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Purpose: This study investigated the current state of critical hemorrhage during home palliative care for terminally ill cancer patients. Methods: We conducted a retrospective medical chart review of 7 cancer patients (1.4%) who received home palliative care from our clinic and died of critical hemorrhage at home from October 2007 to December 2014. Results: Four patients were male, the mean age was 70±11 years, and underlying diseases were different. None of the patients were accompanied by medical staff at the onset of bleeding. Six patients died at home and one patient was admitted to hospital for hemostasis. Six patients had a pre-hemorrhage episode more than 24 hours before critical hemorrhage occurred from the same site. One patient was administered a hemostatic agent, hemostasis was attempted in one, and one was given sedation. Six patients wanted to die at home, and did die at home. Discussion: If terminally ill cancer patients have critical hemorrhage at home, our options are limited. The results of this study suggest the importance of hemorrhage risk assessment and advance care planning.
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<b>Purpose</b>:This study aims to clarify the current situation where palliative care is concurrently performed with cancer therapy, and its effectiveness. <b>Methods</b>:Medical charts of patients cared for at home between April 1, 2012 and March 31, 2013 were retrospectively investigated. <b>Results</b>:14 out of 192 home-care cancer patients were given chemotherapy. The palliative medication period was 192 days and chemotherapy lasted 89.8 days on average. From the beginning of home palliative care until death, patients received chemotherapy for almost half of this period. <b>Consideration</b>:By establishing trust between patients and caregivers, palliative care serves the patients needs well, even after cancer treatment is completed. Home palliative care is a significant part of the entire process.
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[Objective]The purpose of this study was to clarify the current status of cooperation between acupuncturists and physicians providing palliative care at home care support clinics.<BR>[Methods]We studied 297 home care support clinics that provide cancer palliative care in the home. We mailed a self-administered questionnaire to the physicians belonging to the clinics. The questionnaire was created to clarify the number of clinics that provide home palliative care, current status of cooperation with acupuncturists, and methods of information-sharing.<BR>[Results]We received responses from 98 clinics (33.3%response rate). Of these, 14 clinics (14.3%) currently provide care for terminal cancer patients in cooperation with acupuncturists, 9clinics (9.2%) reported having done so in the past. Patient's conditions treated in cooperation with acupuncturists were things such as pain, hiccups, edema, ascites, and constipation. The benefits attributed to cooperation with acupuncturists included "relief of symptoms,""improved patient satisfaction,"and "improved patient motivation."Regarding the presence or absence of information-sharing with acupuncturists, 7clinics (50%) responded that they "always share," 7clinics (50%) responded that they "share depending on the situation,"and no clinic reported "does not share information."Regarding the prospect for cooperation with acupuncturists in providing home palliative care in the future, 9clinics (9.2%) responded that they "actively want to cooperate,"and 65 clinics (66.3%) stated that they would "think about cooperation in some circumstances."<BR>[Conclusion]From this study, it was concluded that cooperation exists between acupuncturists and physicians in 14.3%of home care support clinics providing palliative care. In addition, the possibility that cooperative patient care provides not only symptom relief but also other benefits has been suggested. On the other hand, it is necessary for acupuncturists, as part of a healthcare team, to have access to patient information and the status of other treatments, so that the acupuncturists can be involved in the field of home palliative care. Furthermore, management should promote an environment for cooperating with professionals in other medical occupations, including physicians.
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<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.
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In 1990, I opened a pain clinic, and was very troubled by the chronic pain endured by my patients. <BR>I looked for a better treatment for chronic pain and discovered the benefits of Oriental medicine (acupuncture and Chinese medicine). In 1992, I became a member of the Eastern Medicine Chikugo Study Group (present Eastern Medicine Kiketsu Study Group) led by Dr. Fumitaka Tayama, and studied acupuncture, which was an effective treatment for chronic pain. <BR>In 1999, I started treating patients with cancer. From these patients, I realized the profound need for them to spend their last days at home. Our clinic started in-home palliative care in July 1999. For 13and a half years until December 2012, the clinic offered home medical care to 383patients, and 63%of them, 241 patients, were able to die at home. In 2012, we treated 41 patients at their homes and were present during the final moments of 26 patients (63.4%). Eight patients died at a palliative care unit (19.6%) and 7 patients died at a hospital (17%). Of 41 patients, 10 patients received acupuncture. To treat loss of appetite, general malaise, etc. we inserted press tack needles into acupuncture points LI-11 and ST-36. For all 41 patients, we provided massage therapy on their hands and legs, called "haut care,"using essential oils to stimulate acupuncture points and meridians. When time permitted, we provided the same massage therapy to family members. <BR>Western medicine is said to target the disease, and Oriental medicine treats the whole patient, not just the disease, and I believe that Oriental medicine is really effective. This perspective leads to holistic care, which is the basis of palliative care. Therefore, the study and practice of Oriental medicine has naturally been of great assistance in promoting in-house palliative care. <BR>As a result of studying acupuncture and using it in our treatment, patients with chronic pain as well as cancer patients have started to come to our clinic for treatment. The clinic has received words of appreciation from patients who have had their persistent symptoms alleviated. I have thus reaffirmed my confidence in the effectiveness of acupuncture. I hope to continue to search for better ways to treat my patients suffering from cancer, including the efficacious treatment of acupuncture.
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<b>Purpose and Methods</b>: Aiming at the relief of suffering by the palliative care team and prompt information sharing between healthcare professionals with various specialties, We introduced new IT cloud system, carried out questionnaire survey and examined the usefulness to 11 persons of healthcare professionals. Five cases where the palliative care team was concerned during the hospitalize became a home palliative care to the tried half a year. <b>Results</b>: All the members were using the personal computer as an input device. Four persons were using the iPhone. Two persons had the experience inputted on the spot. Nine persons of the input time were 5 or less minutes. All the members were perusing at various places by various device. Urgently and vital mail was useful: 3 in six, 2 in three, 1 in one, 0 in one. Information content were suitable: 3 in nine, 2 in two. Cooperation were completed in the smooth: 3 in nine, 2 in two. Have you utilized EIR for the home palliative care?: 3 in nine, 2 in two. <b>Conclution</b>: To the support of information sharing and palliative care team by IT cloud system transduction, the useful probability was suggested in the home palliative care.
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In order to promote regional cooperation in palliative care, we developed a regional cooperation clinical pathway for home palliative care that offers simple support and is easy to use. We then administered a questionnaire survey to 14 healthcare professionals with various specialties who were involved in the introduction of the pathway, and we revised the pathway on the basis of the survey results. The revised pathway was then tested in 13 patients who were discharged from 3 designated cancer care hospitals in Toyama City to home care, and another questionnaire survey was conducted afterwards in the same manner. The mean overall score on the questionnaire was 2 in seven, 3 in seven (on a scale of 0 to 3) at the time of introduction, whereas the score after trial use was 1 in one, 2 in four, 3 in five. We believe that more innovative approaches to the implementation of such pathways are required.