Improved knowledge of and difficulties in palliative care among physicians during 2008 and 2015 in Japan: Association with a nationwide palliative care education program

Nakazawa, Yasuo; Yamamoto, Ryo; Kato, Masashi; Kizawa, Yoshiyuki; Morita, Tatsuya

doi:10.1002/cncr.31071

Cited by 41 publications

(21 citation statements)

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“…Among the 22 participating physicians, 12 had trained at a palliative care unit (54.5%) and 17 had participated in the nationwide palliative care education program (77.3%) [27,28] (Additional file 2).…”

Section: Resultsmentioning

confidence: 99%

Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study

et al. 2020

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Background: To improve the quality of advance care planning (ACP) in primary care, it is important to understand the frequency of and topics involved in the ACP discussion between patients and their family physicians (FPs). Methods: A secondary analysis of a previous multicenter cross-sectional observational study was performed. The primary outcome of this analysis was the frequency of and topics involved in the ACP discussion between outpatients and FPs. In March 2017, 22 family physicians at 17 clinics scheduled a day to assess outpatients and enrolled patients older than 65 years who were recognized by FPs as having regular visits. We defined three ACP discussion topics: 1) future decline in activities of daily living (ADL), 2) future inability to eat, and 3) surrogate decision makers. FPs assessed whether they had ever discussed any ACP topics with each patient and their family members, and if they had documented the results of these discussions in medical records before patients were enrolled in the present study. We defined patients as being at risk of deteriorating and dying if they had at least 2 positive general indicators or at least 1 positive disease-specific indicator in the Japanese version of the Supportive and Palliative Care Indicators Tool. Results: In total, 382 patients with a mean age of 77.4 ± 7.9 years were enrolled, and 63.1% were female. Seventy-nine patients (20.7%) had discussed at least one ACP topic with their FPs. However, only 23 patients (6.0%) had discussed an ACP topic with family members and their FPs, with the results being documented in their medical records. The topic of future ADL decline was discussed and documented more often than the other two topics. Patients at risk of deteriorating and dying discussed ACP topics significantly more often than those not at risk of deteriorating and dying (39.4% vs. 16.8%, p < 0.001). Conclusion: FPs may discuss ACP with some of their patients, but may not often document the results of this discussion in medical records. FPs need to be encouraged to discuss ACP with patients and family members and describe the decisions reached in medical records.

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Section: Resultsmentioning

confidence: 99%

Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study

et al. 2020

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“…Canada, the United States, France and Germany, palliative care is organized as a medical subspecialty. 521,522 Other educational programs are directed towards medical specialists associated with some kind of accreditation, which include the Japanese Palliative Care Emphasis Program on Symptom Management and Assessment for Continuous Medical Education (PEACE) 523,524 and The Nordic Specialist Course in Palliative Medicine. 525 The latter is a joint venture between the Associations for Palliative Medicine in the Nordic countries (Denmark, Sweden, Norway, Finland and Iceland) and has resulted in a theoretical specialist training course in six modules over two years combined with a clinical stay at a specialized palliative care unit.…”

Section: Accreditation Of Palliative Medicinementioning

confidence: 99%

Integration of oncology and palliative care: a Lancet Oncology Commission

Kaasa

Loge

Aapro

et al. 2018

The Lancet Oncology

575

539

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Presence of palliative care inpatient consultation team Presence of palliative care outpatient clinic Presence of community based / home palliative care Clinical processes (*) Presence of multidisciplinary specialized palliative care team Routine symptom screening in the outpatient oncology clinic Administration of systemic cancer therapy (e.g. chemo and targeted agents) possible in patients admitted to PC service oncology-and palliative care as well as their cultures. Local variations in terms of resources and practices also probably play a role. By acknowledging integration of oncology and PC as a complex process including different parts of the health care system, both horizontally and vertically, and also involving the patient, we propose SCPs as a means for future efforts to promote integration. For the same reasons, this paper will address integration in different panels. Each panel will address different aspects of integration, ranging from how to focus on the patient, to societal changes and new research areas. Introduction of panels Policy-challenges and frameworks Societal challenges Prognostication Patient-centredness-content methodology and clinical implications Models of palliative care integration The role of education: challenges and recommendations Research The commission is an international collaboration between 30 experts in oncology, PC, public health and psycho-oncology. In October 2016 a kick-off meeting was held in Milan where panel leaders were appointed, the structure of the commission was decided, and a plan for the work was agreed upon. During the two following years each panel expanded with experts within the relevant field, conducted topical literature searches, and an interactive writing process was conducted. Both administrative and academic organization were run from Norway, by Stein Kaasa, Jon Håvard Loge and Tonje Lundeby. Policy-challenges and frameworks Questions to be addressed What type of recommendations is given for integration at the national and international level on policy and public health at present? What are the current examples of different practices in organization of palliative care in different national policies in European countries? What kind of policies and approaches are needed for integration of oncology and palliative care? Patient-centredness-content, methodology and clinical implications Questions to be addressed What is patient-centredness? What are the main elements of patient-centred care in practice? How do we involve the family? Communication-a necessary tool for patient-centred care What are the barriers and solutions to succeed? Research Questions to be addressed What are some opportunities and challenges for integrating oncology and palliative care teams to conduct research together? What are some key research priorities related to integration of palliative care and oncology? What are some key research priorities related to symptom assessment and treatment? What are some key research priorities related to psychosocial support, communication and dec...

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“…Similarly, the Ministry of Health, Labor, and Welfare in Japan has been enhancing the early and continuous delivery of quality care for patients with cancer (both early and advanced stage) from the time point of cancer diagnosis via the Cancer Control Act since 2007 [8,9]. The policy promotion includes comprehensive strategies including PC training for all physicians working at all governmentdesignated cancer hospitals (DCHs), implementation of PC services and routine screening, the establishment of referral criteria to PC services, and public education [8,[10][11][12][13]. However, detailed progress and dissemination of IOP remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Current status of integrating oncology and palliative care in Japan: A nationwide survey

Uneno

Sato

Morita

et al. 2020

Preprint

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Background: Palliative care (PC) is increasingly recognized as essential for oncology care, and several academic societies strongly recommend integrating oncology and palliative care (IOP) in daily practice. Similarly, the Japanese government encouraged the implementation of IOP through the Cancer Control Act of 2007; however, its detailed progress remains unclear. Therefore, this cross-sectional nationwide survey was conducted to investigate the current status and hospital executive physicians’ perception of IOP. Methods: The questionnaire was developed based on IOP indicators with international consensus. It was distributed to executive physicians at all government-designated cancer hospitals (DCHs, n = 399) and matched non-DCHs (n = 478) in November 2017 and the results were compared. Results: In total, 269 (67.4%) DCHs and 259 (54.2%) non-DCHs responded. The number of PC resources in DCHs was significantly higher than those in non-DCHs (e.g., full-time PC physicians and nurses, 52.8% vs. 14.0%, p < 0.001; availability of outpatient PC service ≥3 days per week, 47.6% vs. 20.7%, p < 0.001). Routine symptom screening was more frequently performed in DCHs than in non-DCHs (65.1% vs. 34.7%, p < 0.001). Automatic trigger for PC referral availability was limited (e.g., referral using time trigger, 14.9% vs. 15.3%, p = 0.700). Education and research opportunities were seriously limited in both types of hospitals. Most executive physicians regarded IOP as beneficial for their patients (95.9% vs. 94.7%, p = 0.163) and were willing to facilitate an early referral to PC services (54.7% vs. 60.0%, p < 0.569); however, the majority faced challenges to increase the number of full-time PC staff, and <30% were planning to increase the staff members. Conclusions: This survey highlighted a considerable number of IOP indicators met, particularly in DCHs probably due to the government policy. Further efforts are needed to address the serious research/educational gaps.

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Improved knowledge of and difficulties in palliative care among physicians during 2008 and 2015 in Japan: Association with a nationwide palliative care education program

Abstract: Physicians' knowledge of and difficulties with palliative care improved on a national level. The PEACE program may have contributed to these improvements. Cancer 2018;124:626-35. © 2017 American Cancer Society.

Cited by 41 publications

References 36 publications

Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study

Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study

Integration of oncology and palliative care: a Lancet Oncology Commission

Current status of integrating oncology and palliative care in Japan: A nationwide survey

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