Current Status and Tasks of Bereavement Services in Japanese Hospice and Palliative Care Units: Comparison of Survey Data in 2002 and 2012

Objectives: The purposes of this study are to assess the prevalence and tasks of bereavement services in Japanese hospices/PCUs and to explore these changes through comparison of survey data in 2002 and 2012. Methods: A postal survey of all government-approved hospice and care units in Japan was conducted in 2012. Two hundred twenty-seven questionnaires were dispatched, of which 156 were retuned (response rate, 68.7%). Results: The results of 2012 survey showed that 78% of respondents sent memorial cards, and 73% provided memorial services. The ratios of hospices/PCUs offering diverse bereavement serveces in general decreased over the last decade. “Organizational support” was perceived by 71% of respondents as one of the tasks of bereavement services in 2012 survey. The responses of “caregiver training” and “research on the demands of bereaved individuals” as perceived tasks were declined significantly over the past decade from 2002. Conclusion: These findings in 2012 survey revealed present status of bereavement services in Japanese hospices/PCUs, and suggested that some perceived tasks has been slightly dealt with through comparison with results of 2002 survey.

Decadal trends in the structure and usage status of palliative care units in Japan and the association with length of stay

<b>Background</b>: The aim of this study was to clarify the decadal trends in the structure and usage status of palliative care units in Japan and the association with length of stay. <b>Methods</b>: We conducted a secondary analysis of data from nationwide surveys of palliative care units conducted by Hospice Palliative Care Japan from 2002 to 2012. Length of stay was divided into three categories (within 30 days, 31 to 60 days, and 61 days or more). <b>Results</b>: Significant decadal trends in usage status were observed: the mean annual number of admitted patients (119±55 persons in 2001, 163.0±77.7 in 2011, <i>p</i>＜0.001), and deaths (99±44, 136±58, <i>p</i>＜0.001) increased and the mean length of stay in a palliative care unit (8±15 days, 39±15, <i>p</i>＜0.001) decreased. Palliative care units with a shorter mean length of stay had significantly more admitted patients, and more discharged patients, and a significantly lower mean ratio of death to discharge, and a lower bed availability rate. In contrast, length of stay was not significantly associated with the structure of palliative care units, including the type of units, number of inpatient beds, percentage of private rooms, and number of staff. <b>Conclusion</b>: The features of decadal trends in the structure and usage status of palliative care units in Japan were a shortening of length of stay, and an increase in the number of patients. Palliative care units with a shorter mean length of stay cared for a larger number of terminally ill patients.

Evaluations and needs of bereavement services among the bereaved whose family member died at palliative care units

<b>Objectives</b>: The purpose of this study is to clarify evaluations and needs of bereavement services among the bereaved whose family member died at palliative care units. <b>Methods</b>: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the items concerning bereavement services provided by palliative care units and other resources, and the Center for Epidemiologic Study Depression Scale (CES-D). <b>Results</b>: Of the 661 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 68%). The results revealed that 49% of respondents received "memorial cards". Bereavement services were evaluated positively by 88-94% of respondents. The bereaved relatives with higher level of depressive symptoms signicicantly asked for bereavement services. <b>Conclusion</b>: These findings did not suggest the efficacies of some beravement services provided by a specified unit, but that of each service itself at palliative care units. And this result supported the notion that all the bereaved did not equally want any beravement services.

Complicated grief, depressive symptoms, and suicidial ideation among the bereaved whose family member died at palliative care units

<b>Objectives</b>: The aim of this study is to explore prevalence and determinants of complicated grief, depressive symptoms, and suicide ideation among the relatives whose family members died in palliative care units. <b>Methods</b>: A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who were admitted to palliative care units in Japan. Participants completed self-report questionnaire including the Center for Epidemiologic Study Depression Scale (CES-D), Inventory of Traumatic Grief (ITG), the item concerning suicide ideation, Care Evaluation Scale (CES), and Good Death Inventory (GDI). <b>Results</b>: Of the 653 questionnaires sent to bereaved family members, 451 responses were analyzed (response rate: 67%). The results showed 10 (2.3%) respondents with complicated grief and 153 (43.8%) with depressive symptoms. Suicide ideation was appeared among 52 (11.9%) respondents. Multiple regression analysis revealed that ITG was signicicantly associated with both CES and GDI. Patiens' age at death and pre-bereavement health contributed to the suicide ideation of the bereaved family members. <b>Conclusion</b>: The prevalence of complicated grief and depressive symptoms among the relatives whose family members died in palliative care units were 2.3% and 43.8%, respectively. The rates of suicide ideation was 11.9% of respondents. The results suggested that the evaluations about structure and process of palliative care, and quality of death contribute to better adjustment of the bereaved.

Counting the use of specialized palliative care services

The primary aim of this study was to compare the ratios of specialized palliative care use to all cancer death using 2 methods: 1) total number of patients who received either of specialized palliative care services (unadjusted), and 2) number of patients after adjustment of potentially duplicated counts (adjusted). The research team obtained patient list from all specialized palliative care services, and counted the number of the patients who received any specialized palliative care services. The ratio of adjusted value to unadjusted value was 0.59, and had large region differences.Unadjusted values had, although overestimated, essentially similar trends in changes by year and differences in the regions. In conclusion, total number of patients who received either of specialized palliative care services could be simple and feasible indicator to roughly determine the activity of specialized palliative care services, but exact number of the patients who received specialized palliative care services should be determined on the basis of the patient lists without duplicated counts.