Objective：The aim of the present study was to clarify issues for community care collaboration based on a death conference between hospital staff and community care practitioners who reviewed their support in the process from disease onset to death for a patient with amyotrophic lateral sclerosis.Methods：Data were collected from the conference materials and written conference records of the participantsʼ opinions. The researchers discussed and summarized the data to extract community care collaboration issues. The case in question involved a woman in her 60s who died following emergency hospitalization after 7 years and 6 months of medical treatment during which she had been hospitalized five times. She had received care from multiple community support staff, including nurses from two visiting nurse stations and doctors from three medical clinics. Results and Discussion：The number of changes of treatment location, the increased caregiver burden due to symptom deterioration, and the end-of-life stage represented crisis situations in the present case. After these situations were considered, the following issues requiring community care collaboration were emphasized： reduction of the family caregiver burdenʼ,family guidance and careʼ,collaboration between the hospital and the community attending physicianʼ andimprovements of the terminal care systemʼ.

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease for which there is currently no cure. This study aimed to explore the situations with which nurses struggled, their implemented practical measures, and the challenges they experienced when caring for patients with ALS comorbid with cognitive impairment (hereinafter, targeted patients). In this qualitative study, we conducted a survey with nurses (n = 121) experienced in caring for ALS patients; the survey contained a free-writing section in which participants described their struggles regarding care delivery for these patients. To collect data on practical measures that nurses had already implemented or wanted to propose regarding care delivery for the targeted patients, we conducted four focus group interviews (n = 22). We used a qualitative inductive approach to extract the categories. Fifty-eight nurses (49.6%) completed the free-writing survey section. The situations in which nurses struggled in care for the targeted patients were organized into three categories: “Patients’ strong persistency on specific requirements for nursing assistance in their daily lives,” “Patients’ problematic behaviors toward nurses,” and “Struggles in communicating with and understanding patients’ wishes.” Nurses reported these situations as stressful, and they affected care quality. The practical measures implemented when caring for the targeted patients were organized into five categories: “Cognitive impairment assessment,” “Care delivery to deal with patients’ strong persistency on specific requirements for assistance in their daily lives,” “Communication,” “Supporting the decision-making process,” and “Collaboration between the hospital and the community.” Multidisciplinary collaboration in the hospital, and collaboration between the hospital and the community from an early stage is necessary to share the results of the assessment and diagnosis of cognitive impairment. Our evidence underlines that guideline and care manual establishment may lead to improved care delivery and to the unification of care deliveries to respond to patients’ strong persistency.

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Purpose:The number of elderly patients with multiple coexisting diseases is increasing. While ALS is a designated intractable disease and characterized by rarity, the number of ALS patients with cancer is also increasing. In order to consider support for ALS and cancer coexisting cases, we aimed to organize existing case reports from literature review and obtain basic data. Method: We searched the literature from 2010 to 2021 using the Japan Central Revuo Medicina Web (ver. 5) electronic database, with a combination of 'amyotrophic lateral sclerosis' and 'cancer' . We extracted a total of 26 cases from 23 articles.Results: Out of the 23 articles, the first authors were physicians in 18 articles. In our analysis of 26 cases, 54％ of the patients were in their 70s or over; 18 (69％) cases were diagnosed with ALS before cancer, 3 (12％) with cancer first, and 5 (19％) with both at about the same time. The literature included 9 cases related to surgery, 5 cases for anesthesia for surgery, and 4 cases related to either chemotherapy or radiotherapy. Nine patients were under respiratory management with TPPV. In all but three reports of ALS patients treated for cancer, the cancer treatments were described as successful. Conclusion: Although multidisciplinary, interdisciplinary, and comprehensive consideration for each case is necessary, recent advances in treatment technology have revealed that aggressive cancer treatment is being used for ALS, which is an incurable disease. This study presented a reference material in decision-making support for ALS patients.

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