End-of-life (EOL) discussions for patients with cancer are a key factor of successful EOL care; however, identifying the optimal timing for these discussions in Japanese home-care settings is difficult. To identify the time at which patients with cancer and their caregivers need EOL discussions, we explored when home-visit nurses start EOL discussions. We interviewed 23 home-visit nurses and analyzed the data using qualitative content analysis. Three themes were derived from the analysis. Participants identified the timing of EOL discussions as being sensitive to patients’ changing health and care needs (increases in patient’s total pain), changes in the family caregiver’s physical or mental condition through daily care (increases in family caregiver distress), and the EOL process that patients follow (trajectory of disease). Developing a tool or in-service educational program that will enable inexperienced or new graduate home-visit nurses to implement EOL discussions at appropriate times is necessary.

Purpose: To clarify the subjective experience and coping with multiple symptoms of outpatients with metastatic and recurrent breast cancer receiving chemotherapy. Methods: Twenty outpatients with metastatic and recurrent breast cancer receiving chemotherapy participated in semi-structured interviews. We used an inductive approach to qualitatively analyze the responses. Results: Responses regarding subjective experience could be grouped into three categories: "I feel that daily life routine is interrupted due to overlapping of multiple symptoms," "I feel irritated that I have no control over my symptoms," and "I fear whether I can continue chemotherapy." Responses regarding coping with multiple symptoms could also be grouped into three categories: "I explore skills to control multiple symptoms better," "I am aware of the changes my body is going through and foresee the future," and "I want to avoid further damage to my weakened body." Conclusion: It is necessary for nursing care to capture patients' difficulties in daily life caused by multiple and variable symptoms. Moreover, nursing professionals should pay close attention to patients who are dealing with the uncertainties regarding metastatic recurrence in order to provide effective personalize care. Future research is warranted to identify core symptoms and to develop assessment tools to detect them.