Survey of the Circumstances of Cancer Patients Treated at Home and the Presence of Doctors and Nurses at the Time of Death

In recent years, the system for providing home medical care and palliative care has been improved, and the number of cancer patients who are treated at home until the end is increasing. The aim of this study was to investigate the circumstances of cancer patients who died at home and the presence of doctors and nurses at the moment of death. We conducted a prospective survey of end-oflife cancer patients receiving home visits from home care and palliative care clinics in Japan from 1st July to 31st December 2017. During the study period, we analyzed the mortality status of 676 patients who died in their homes, serviced by 45 clinics. Of these patients, 91% were living with families, 49% died on holidays or at night, and the doctor and nurse was present at the time of death in only 5.6% and 9.9% of cases, respectively. Most of the patients who died at home lived with their families, with few doctors and nurses present at the time of their patients’ death.

Survey of diet and meal preparation by Japanese bereaved caregivers for terminal cancer patients followed at home

The aim of this study was to clarify diet and meal preparation for terminal cancer patients followed at home. A cross-sectional survey was administered to bereaved caregivers of 200 cancer patients who received home care from five palliative care clinics in Kobe in 2014. The response rate was 66% and the average age of the caregivers was 62 years. Overall, 57% of caregivers reported distress regarding diet and meal preparation for patients. The independent determinants of distress were: the experience of coaching from medical staff （P=0.012）; how to help patients with eating; difficulties in cooking and meal preparation （P=0.001）; and helping with eating for anorexic patients （P=0.004）. Due to the paucity of the evidence about diet and meal preparation for cancer patients, caregivers may not be receiving sufficient specific and practical dietary instruction from medical staff.

Japanese family bereavement survey of diet and complementary and alternative medicine in terminal cancer patients followed at home

The aim of this study is to clarify the diet and complementary and alternative medicine among terminal cancer patients followed at home. A cross-sectional survey of bereaved families of 200 cancer patients who were received home care by 5 palliative care clinics in Kobe in 2014. The response rate was 66％. The average age of the patients was 74 years old. The family members received the information about diets from books, magazines, and newspaper（48％）and medical staff（46％）. The patients actively took in tea（64％）, dairy（62％）, and soy（60％）. The patient avoided alcohol（49％）, fat（31％）, and salt（31％）. The question asking the complementary and alternative medicine（CAM）, 32％ respondents answered using CAM, of which 28％ took mineral supplements, and vitamins. Due to the paucity of the evidence about the diet and CAM for cancer patients, the patient and family tend to practice the general diet therapy.

Palliative sedation for terminally ill cancer patients at home in Japan：A retrospective analysis

Some terminally ill cancer patients are treated with palliative sedation（PS）to alleviate their suffering. There have been very few studies in Japan investigating PS in the home. Thus, the aim of the present study was to investigate PS at home for terminally ill patients. A retrospective chart review was performed of 117 cancer patients who died at home between August 2012 and July 2014. Of the 73 who patients died at home, 24（33％）had received PS. The mean duration of PS was 4.4±6.0 days. Patients receiving PS were started on a mean dose of 12.8±6.2 mg/day midazolam；the mean dose at the end of PS was 12.4±6.5 mg/day midazolam. The primary reason for starting PS was delirium（n＝22）. PS in the home was feasible and was an essential treatment for cancer patients at home. We conclude that PS can be used safely and efficaciously to treat terminally ill cancer patients with refractory symptoms in their own home.

A survey of end of life care at long-term care facilities in urban areas in Japan

The aim of this study was to investigate the end of life care provided by long-term care facilities and nursing homes. A cross-sectional survey of all long-term care facilities and nursing homes in Kobe was performed in July 2013. Questionnaires were sent to 350 facilities with an 89.7％ response rate. In total, 121（39％）of respondents stated that end of life care was available, and 151（48％）responded that facilities were willing to provide end of life care for terminally ill residents. One hundred fifty-two（48％）and 183（58％）of respondents answered that facilities were available for managing residents with percutaneous endoscopic gastrostomy, and transfusion, respectively. Seventy-two（23％）of respondents reported that facilities for managing the use of narcotics were available. In conclusion, a minority of long-term care facilities and nursing homes ware available for providing end of life care for residents, though approximately 50％ were willing to do so.

A survey of home care provided by hospitals and clinics in an urban area of Japan

<b>Objective：</b>The aim of this study was to investigate the current status of home care provided by hospitals and clinics in Kobe City. <b>Methods：</b>In July 2013 a survey was mailed to a cross-section of all clinics and hospitals in Kobe City.<b> Results：</b>Questionnaires were sent to 1,589 clinics and hospitals and 899（57％）responded. Regular and urgent home visits by doctors were provided by 50％ and 65％ of respondents, respectively. End-of-life care for dying patients at home and in nursing homes was provided by 31％ and 18％ of respondents, respectively. The average time spent on home visits was 2.3±1.7 days per week. Care for cancer patients, participation in national palliative care lectures, and holding a discussion at the admitting hospital before discharge for home care, were performed by 23％, 7.0％, and 6.9％ of respondents, respectively. <b>Conclusion：</b>The majority of hospitals and clinics in Kobe City provided home care.

Factors contributing to the burden of home care for doctors

<b>Objective</b>: The aim of this study is to explore the factors associated with the burden of home care for doctors. <b>Methods</b>: In July 2013 a survey was mailed to a cross-section of clinics and hospitals in Kobe City. <b>Results</b>: Questionnaires were sent to 1,589 clinics and hospitals and 899 (57%) responded. Of these, data from 807 respondents were available for analysis. The burden of home care was felt to be considerable for 30% and slight for 31% of respondents. Determinants associated with the burden of home care were; 80 years and older doctors (<i>P</i>=0.05), particular medical measures (<i>P</i>=0.036), building links with other medical facility or care staff (<i>P</i>=0.002), and ensuring the sufficient time and staff (<i>P</i><0.001). <b>Conclusion</b>: The majority of doctors reported a burden associated with home care.