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Administrators’ perspectives on end-of-life care for cancer patients in Japanese long-term care facilities

  • Supportive Care International
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Abstract

Purpose

The purpose of this study was to clarify administrators’ perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan.

Methods

A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care.

Results

The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient’s condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%).

Conclusion

Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

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Financial disclosure

This study was supported by a grant-in-aid for the Third Term Comprehensive Strategy for Cancer Control in Japan.

Authors’ contributions

Morita, Miyashita, Akizuki, Akiyama, Shirahige, and Eguchi were responsible for the study concept and design; Miyashita, Ichikawa, Akizuki, Akiyama, and Shirahige for the acquisition of subjects and data; Fukahori and Miyashita for the analysis and interpretation of data; and Fukahori, Morita, Miyashita, Ichikawa, Akizuki, Akiyama, Shirahige, and Eguchi for the preparation of the manuscript.

Sponsor’s role

None.

Author information

Authors and Affiliations

  1. Department of System Management in Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8591, Japan

    Hiroki Fukahori

  2. Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Mitsunori Miyashita & Takayuki Ichikawa

  3. Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Hamamatsu, Shizuoka, 433-8558, Japan

    Tatsuya Morita

  4. Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Nobuya Akizuki

  5. Faculty of Policy Management, Keio University, 5322 Endo, Fujisawa, Kanagawa, 252-8520, Japan

    Miki Akiyama

  6. Shirahige Clinic, 1-13-28 Katafuchi, Nagasaki, Nagasaki, 850-0003, Japan

    Yutaka Shirahige

  7. Department of Internal Medicine and Medical Oncology, Teikyo University School of Medicine, Itabashi-ku, Kaga 2-11-1, Tokyo, 173-8606, Japan

    Kenji Eguchi

Authors
  1. Hiroki Fukahori
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  2. Mitsunori Miyashita
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  3. Tatsuya Morita
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  4. Takayuki Ichikawa
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  5. Nobuya Akizuki
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  6. Miki Akiyama
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  7. Yutaka Shirahige
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  8. Kenji Eguchi
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Corresponding author

Correspondence to Hiroki Fukahori.

Additional information

This study was presented at the 13th Congress of the Japanese Society for Palliative Medicine held in Shizuoka Prefecture, Japan.

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Fukahori, H., Miyashita, M., Morita, T. et al. Administrators’ perspectives on end-of-life care for cancer patients in Japanese long-term care facilities. Support Care Cancer 17, 1247–1254 (2009). https://doi.org/10.1007/s00520-009-0665-8

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  • DOI: https://doi.org/10.1007/s00520-009-0665-8

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