Pre-post-evaluation of a dementia-specific advance care planning toolkit for Japanese primary care clinicians.

BACKGROUND: The population of people living with dementia (PLwD) continues to grow in Japan where advance care planning (ACP) for PLwD is relatively new. Our aim was to evaluate the feasibility and cultural acceptability of a dementia-specific ACP communication skills toolkit for Japanese primary care clinicians. METHODS: We delivered 13 training sessions in primary care clinics across central Japan and conducted a post-training survey to assess whether the toolkit increased confidence in dementia-specific ACP communication skills and the acceptability of the toolkit with the following four statements: (1) The language in the sessions was clear, (2) The sessions took an appropriate amount of time to complete, (3) The design of the sessions was an effective educational method, and (4) The sessions were culturally appropriate for communication with Japanese patients with dementia and their family members. We asked participants to respond using a 5-point Likert scale from strongly agree to strongly disagree. RESULTS: All participants were Japanese and included 80 physicians (mean age 39.8 years), 33 nurses (mean age 45.7 years), and 58 other participants (mean age 42.9 years), who were 30.0%, 87.9%, and 55.2% female, respectively. Most participants practiced in rural settings. In pre- post-comparisons, participant confidence increased in determining capacity, understanding dementia prognosis, goals of care, eliciting surrogates, recommending self-care practices to families, and leading family meetings (all p < 0.001). Most participants strongly agreed or agreed that the toolkit was an effective method (96.9%), took an appropriate amount of time (94.5%), contained clear language (89.8%), and was culturally appropriate (73.6%). CONCLUSIONS: Dementia-specific ACP communication skills toolkit can be delivered in Japan. Japanese primary care clinicians generally felt the dementia-specific ACP toolkit increased their confidence in ACP communication skills and was acceptable. The language, time, and design were well received, though further work is needed to improve the cultural appropriateness of the toolkit.

IMPACT the Brain: A Team-Based Approach to Management of Metastatic Breast Cancer With CNS Metastases.

PURPOSE: CNS metastases are associated with decreased survival and quality of life for patients with metastatic breast cancer (MBC). Team-based care can optimize outcomes. IMPACT the Brain is a care coordination program that aims to improve access to team-based care for patients with MBC and CNS metastases. MATERIALS AND METHODS: Patients with MBC and CNS metastases were eligible for enrollment in this care coordination program. A team of specialists supported a dedicated program coordinator who provided navigation, education, specialty referral, and clinical trial screening. A unique intake form developed for the program created personalized, coordinated, and expedited specialty referrals. Patient-reported outcomes and caregiver burden assessments were collected on a voluntary basis throughout enrollment. Data were analyzed using descriptive statistics. RESULTS: Sixty patients were referred, and 53 were enrolled (88%). The median time to program enrollment was 1 day (range, 0-11) and to first visit was 5 days (range, 0-25). On the basis of the program intake form, 47 referrals were made across six specialties, most commonly physical medicine and rehabilitation (n = 10), radiation oncology (n = 10), and neuropsychology (n = 10). Nineteen patients (36%) consented to enroll in clinical trials. CONCLUSION: A tailored team-based care coordination program for patients with MBC and CNS metastases is feasible. Use of a unique intake screening form by a dedicated program coordinator resulted in faster time to first patient visit, enabled access to subspecialist care, and supported enrollment in clinical trials. Future research should focus on intervention development using PRO data collected in this care coordination program.

What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation.

To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005-2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5-9.9, P<.01) and consultations for assistance with plan of care (aOR=11.6, 95% CI=5.6-23.9, P<.01) were independently associated with in-hospital death. Patients with both consultation for plan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9-88.5, P<.001), followed by patients with consultation for plan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3-22.1, P<.001), and patients with long pre-consult LOS but no consultation for plan of care (aOR=4.7, 95% CI=1.8-12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death.

Herb and vitamin supplementation use among a general ophthalmology practice population.

PURPOSE: To survey comprehensive ophthalmology patients about their use of vitamins and herbal supplements. DESIGN: Cross-sectional survey. METHODS: A survey instrument was developed and distributed to 397 patients presenting to a main campus university-based comprehensive ophthalmology clinic and to an off-site comprehensive ophthalmology clinic. Information gathered included demographics, use of prescription medications, use of vitamin and herbal supplements, the reasons for using these supplements, perceived benefits of these products, where the information regarding them was gathered, and with whom patients had discussed their use. RESULTS: Fifty-eight percent of patients reported nearly daily use of vitamins. Multivitamins were the most common vitamin and were used by 46% of the patients. Eight percent of patients used herbal products on a daily basis. Twenty-six percent learned about vitamins from their primary care physician (PCP), and just 2% from their ophthalmologists, while 35% discussed their actual use with a PCP, and 5% with their ophthalmologists. Just 2% of these patients learned of herbs from a PCP, and <1% from an ophthalmologist. Older patients used multivitamins and other vitamins most frequently, while gender and education were not predictive of vitamin or herbal use. Mean monthly spending on vitamins by users was 15.74 dollars, while herbal users spent a monthly mean of 15.35 dollars. CONCLUSIONS: Vitamins and herbs are used by a significant number of patients in a comprehensive ophthalmology setting. Given the prevalence of vitamin and herbal use, ophthalmologists should systematically inquire about their use.

[Development of disease burden score concerning bone and joint diseases: comparison between rheumatoid arthritis and osteoarthritis].

OBJECTIVES: To develop disease burden score concerning bone and joint diseases by evaluating the burdens of rheumatoid arthritis (RA) and osteoarthritis (OA) based on two quantitative measures of quality of life (QOL). METHODS: In a questionnaire, the qualified doctors of Japan Rheumatism Foundation were asked to evaluate patients' QOL, including 6 items of physical functions, 7 items of daily living activities and 3 items of social activities, for three severity levels defined by treatment status. The burdens of RA and OA were determined based on two quantitative measures of QOL, that is, 'principal component score' and '0-0.5-1 score'. RESULTS: In the two-way ANOVA of severity level and doctor's specialism, two quantitative measures of QOL showed significant differences by severity level, having approximately the same F-statistics each other. The burden of RA was 1.4-times (for 'principal component score') and 1.6-times (for '0-0.5-1 score') as great as that of OA. The differences in burden between RA and OA were observed especially in daily living activities and social activities. CONCLUSIONS: Our methodology may be applicable to examining differences in burden between bone and joint diseases.