To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This study aimed to validate the Japanese versions of the Trust in Oncologist Scale (TiOS-J) and the TiOS-Short Form (TiOS-SF-J).
A cross-sectional web-based survey was conducted among cancer patients in Japan. The forward-backward translation method was used to develop the TiOS-J. The web-based survey was mailed to 633 people, of whom 309 responded. After 2 weeks, 103 among the 156 first-time respondents completed the second survey to verify the reliability of the retest method. The validity was evaluated by exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Spearman’s correlation coefficients between the Patient Satisfaction Questionnaire-Japanese, willingness to recommend the oncologist, trust in health care, and number of oncological consultations. To evaluate reliability, Cronbach’s α and test–retest correlation were calculated.
The theoretically driven four-factor model and the EFA-driven one-factor model of the full-form TiOS-J (18 items) did not result in an acceptable fit; however, CFA supported the one-dimensionality of the 5 items from the TiOS-SF-J (χ2 (5) = 12.36, p = 0.03, goodness-of-fit index = 0.984, adjusted goodness-of-fit index = 0.952, comparative fit index = 0.991, and root mean square error of approximation = 0.069). With regard to the reliability of TiOS-J and TiOS-SF-J, the Cronbach’s alpha values were 0.94 and 0.89, respectively; the test–retest values were 0.82 and 0.78.
Significance of Results
This study indicated that the TiOS-J and TiOS-SF-J are valid and reliable instruments for measuring patients’ trust in their oncologists and can be used to assess trust in oncologists for both clinical and research purposes.
The goal of palliative and supportive care is to improve patients’ quality of life (QoL). Patient-reported outcome measures (PROMs) are the gold standard for the assessment of QoL and symptoms; however, when self-reporting is complicated, PROMs are often substituted with proxy-reported outcome measures, such as clinician-reported outcome measures. The objective of this study was to assess the validity and reliability of the Japanese version of the Integrated Palliative care Outcome Scale (IPOS) for staff (IPOS-Staff).
This multicenter, cross-sectional observational study was conducted concurrently with the validation of the IPOS for patients (IPOS-Patient). Japanese adult patients with cancer and their staff were recruited. We assessed the characteristics of the patients and staff members, missing values, prevalence, and total IPOS scores. For the analysis of criterion validity, intra-rater, and inter-rater reliability, we calculated intraclass correlations (ICCs).
One hundred and forty-three patients completed the IPOS-Patient, and 79 medical staff members completed the IPOS-Staff. The most common missing values from IPOS-Staff were Family Anxiety (3.5%) and Sharing Feelings (3.5%). Over half of the patients scored themselves moderate or worse for Poor Mobility, Anxiety, and Family Anxiety, while staff members scored patients moderate or worse for Weakness, Anxiety, and Family Anxiety. For criterion validity (patient–staff agreement) as well as intra-rater and inter-rater reliability, ICCs ranged from 0.114 (Sharing Feelings) to 0.826 (Nausea), 0.720 (Anxiety) to 0.933 (Nausea), and −0.038 (Practical Problems) to 0.830 (Nausea), respectively.
Significance of results
The IPOS-Staff is easy to respond to; it has fair validity and reliability for physical items but poor for psycho-social items. By defining the context and objectives of its use and interpretation, the IPOS-Staff can be a useful tool for measuring outcomes in adult patients with cancer who cannot complete self-evaluations.
There is no tool to appropriately assess terminal delirium, including the natural terminal course. The objective of this study was to develop an evaluation scale to assess distress from irreversible terminal delirium and to examine the validity of the scale.
Based on previous qualitative analysis and systematic literature searches, we carried out a survey regarding the views of bereaved families and developed a questionnaire. We extracted items that bereaved families regarded as important and constructed an evaluation scale of terminal delirium. Then, we applied the questionnaire in a cross-sectional questionnaire survey of bereaved relatives of cancer patients who were admitted to a hospice or a palliative care unit.
We developed the Terminal Delirium-Related Distress Scale (TDDS), a 24 item questionnaire consisting of five subscales (support for families and respect for a patient, ability to communicate, hallucinations and delusions, adequate information about the treatment of delirium, and agitation and restlessness). Two hundred and eighty-one bereaved relatives participated in the validation phase. The construct validity was shown to be good by repeated factor analysis. Convergent validity, confirmed by the correlation between the TDDS and the Care Evaluation Scale (r = 0.651, P < 0.001), was also good. The TDDS had good internal consistency (Cronbach's alpha coefficient for all 24 items = 0.84).
Significance of results
This study showed that the TDDS is a valid and feasible measure of irreversible terminal delirium.
To obtain preliminary knowledge to design a randomized controlled trial to clarify the effects of spiritual care using the Spiritual Pain Assessment Sheet (SpiPas).
The study was designed as a nonrandomized controlled trial. The study took place between January 2015 and July 2015 in a hematology and oncology ward and two palliative care units in Japan. Among 54 eligible patients with advanced cancer, 46 were recruited (24 in the control group vs. 22 in the intervention group). The intervention group received spiritual care using SpiPas and usual care; the control group received usual care. The primary outcome was the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). The secondary outcomes were the Hospital Anxiety and Depression Scale (HADS) and Comprehensive Quality of Life Outcome (CoQoLo).
A total of 33 (72%) and 23 (50%) patients completed 2- and 3-week follow-up evaluations, respectively. The differences in the changes during 2 weeks in total scores of FACIT-Sp and HADS were significant (95% confidence intervals, 3.65, 14.4, p < 0.01; –11.2 to –1.09, p = .02, respectively). No significant changes were observed in the total score of CoQoLo.
Significance of results
Spiritual care using the SpiPas might be useful for improving patient spiritual well-being. This controlled clinical trial could be performed and a future clinical trial is promising if outcomes are obtained within 2 weeks.
The present study sought to examine the impact of physical symptoms, facial disfigurement, adequacy of preoperative information, and social support on anxiety and depression in Japanese patients with head and neck cancer (HNC) who had undergone surgery.
A cross-sectional study with 194 patients was conducted using a self-administered questionnaire. This instruments included the Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer (EORTC) Head and Neck cancer module (QLQ–H&N35), and a Social Support Scale developed by Okabayashi et al. (1997).
The majority (56.7%) had surgery two or more years before completing the questionnaire. More than 25% of respondents showed anxiety or depression. Higher levels of perceived social support were associated with lower rates of anxiety and depression (p < 0.01). Sensory problems were associated with anxiety, and reduced sexuality was associated with depression (p < 0.01). Perceived disfigurement and adequacy of preoperative information were not associated with anxiety or depression.
Significance of Results:
Survivors of HNC experience anxiety and depression for an extended period of time. Social support may alleviate the severity of these disorders. More research is needed to confirm the impact of facial disfigurement and that of the preoperative information provided by surgeons on psychological distress in HNC patients.
This study investigates the views on death among cancer patients in Japan and examines how these views are related to age, sex, and physical condition. We also investigate how these views are related to where patients would like to spend their final days and whether or not they would like to be told how long they have left to live.
We targeted 450 cancer patients receiving outpatient treatment in the radiology department at the University of Tokyo Hospital. We used the Death Attitudes Inventory (DAI) developed by Hirai to measure attitudes about death.
Of the 450 patients approached, we received responses from 310 (69% collection rate). The results of the t test and one-way ANOVA showed that, in terms of “death anxiety/fear,” the under-65 group (17.73 ± 6.69) scored significantly higher than the 65-and-over group (15.43 ± 7.69, t = 2.685, df = 280, p < 0.01); the group with KPS scores 70 or above (16.88 ± 7.21) scored higher than the group with KPS scores below 70 (12.73 ± 7.09, t = 2.168, df = 280, p = 0.03); and no significant difference was found for sex, metastasis, or treatment stage.
Significance of results:
Our results demonstrate that, although views on death among cancer patients may differ according to sex, age, and physical condition, taking these factors into account when understanding such views can be useful in predicting where patients may wish to spend their final days.
One of the most important goals of palliative care is achieving a good death. Most Japanese believe that “having some pleasure in daily life” is necessary at the end of life. The aim of this study was to identify, from the perspective of physicians and nurses, a care strategy that ensures that cancer patients have pleasure in daily life at the end of life.
We conducted semistructured interviews with experts in palliative care units. A total of 45 participants included 22 palliative care physicians and 23 nurses. Transcripts of the interviews were analyzed using a content analysis method.
Care for end-of-life cancer patients that ensures they have some pleasure in daily life was classified into five categories: “Pain assessment and pain easing” aimed to offer physical and psychological pain assessment and relief. “Maintenance of recuperative environment” aimed to offer care that arranged for assistive devices and equipment in the patient's room. “Support of daily life” aimed to offer care that eased accomplishment of daily activities. “Care that respects individuality” aimed to offer care that assessed sources of pleasure for the patient. “Events and complementary and alternative therapies” aimed to offer such care as aromatherapy and massage.
Significance of results:
The elements of care identified in this study are useful for all end-of-life cancer patients, even those who do not enter palliative care units. The next step of research is to test the efficacy of interventions that reflect the five identified categories of care for end-of life cancer patients.
This study assessed the factor structure, internal consistency, and concurrent and discriminant validity of a scale used to measure social distress in Japanese head and neck cancer outpatients with facial disfigurement.
The sample included 225 Japanese outpatients with head and neck cancer, including 129 patients with facial disfigurement. Participants' level of social distress was assessed through our scale, the European Organization for Research and Treatment Cancer questionnaire (EORTC) QLQ-H&N35 and the Hospital Anxiety and Depression scale (HADS).
Factor analyses confirmed the structure of two subscales of the social distress scale. Social distress was significantly correlated with the social contact subscale of the EORTC QLQ-H&N35 and the HADS.
Significance of results:
Results demonstrated preliminary reliability and validity of the social distress scale. This scale may extend social adjustment research by revealing its determinants and effects for head and neck cancer with facial disfigurement in Japan.
Although the number of hospital-based palliative care consultation teams (PCCTs) is rapidly increasing in Japan, there is limited information available concerning the activities and usefulness of PCCT in the country. The aim of this study is to clarify the activities, patient outcome, and referring staff's view of an established PCCT in Japan.
This was a prospective study to follow patients referred to a PCCT for 28 days over a 1-year period. Patients were assessed by the Support Team Assessment Schedule–Japanese version (STAS-J) and EORTC QLQ C-30 at the time of referral and on days 7, 14, and 28. A staff survey was implemented using a questionnaire after each observation period.
Of 180 patients referred, 53 patients were eligible for the study. Although the median of the number of the reasons for referral was 1, the PCCT provided several kinds of support: pain management, 94%; emotional support for the patient, 49%; and emotional support for the family, 36%. On day 7 after referral, of the items of STAS-J and the EORTC QLQ C-30 subscales, only insomnia improved significant whereas “other physical symptoms” and constipation were significantly exacerbated. In the staff survey, of the 98 respondents, more than 90% considered the effect of the PCCT as “excellent” or “good” and were satisfied with the support provided.
Significance of results:
This study showed that the PCCT performed comprehensive assessments on referred patients and provided extra support. No patient's QOL 1 week after referral was improved with the exception of insomnia. Referring staff highly evaluated the activities of the PCCT. In the evaluation of PCCTs, further research about the variation of clinical activities of PCCTs, their applicability, and benefit is needed.
The aim of the study was to clarify the care experience of primary caregivers when caring for a terminal cancer patient in the home with the assistance of a home palliative care service. Participants were asked to provide background data and to evaluate their experience of caregiving and of the patient's response throughout the period of home palliative care, up to the time of death.
One hundred twelve primary family caregivers were a mailed self-report questionnaire, and 74 valid questionnaires were returned (response rate 66%).
Ninety percent felt that the patient's condition of mind and body was reasonably stable, and 75% felt that the death was peaceful. About 90% reported a deepening of their bond with the patient and that the bond of other family members deepened also. Sixty percent reported that the burden of caregiving was not too great or not felt at all. Approximately 90% judged that the patient retained his or her own personal qualities to the end. Ninety percent also felt that they had done their best in their caregiving and judged that home care had been beneficial for the deceased, for the primary caregiver him/herself, and for other family members. These primary caregivers' evaluations of caring for a terminally ill patient at home in conjunction with a home palliative care service were both high and positive.
Significance of results:
Our findings suggest that it is important to maintain the patient's personal qualities up to the time of death through appropriate symptom management, to respect the family bond of the household, and to provide professional support in order to reduce the load on the family. If appropriate care is provided, peaceful home death will be possible, resulting in significant benefits for patients and their families in Japan.
Objective: To assess the willingness of Japanese terminally
ill cancer patients to continue living at home during the early phase of
home care after discharge from a Clinical Cancer Center (CCC) in Japan,
and to identify factors relating to their willingness to continue living
Methods: A cross-sectional questionnaire survey of a
convenient sample of both Japanese terminally ill cancer patients and
their caregivers (PFCs) was conducted (n = 294, effective
response rate 25.0%). Questionnaires were mailed and medical records were
accessed for 73 pairs of respondents, comprising one terminally ill cancer
patient and one PFC.
Results: At about 10 days after discharge, 64 patients (88%)
wished to continue living at home. A hierarchical logistic regression
analysis was performed on the data. It was found that the fewer the
medical treatments undergone (OR = 0.20, 95% CI: 0.05–0.72), the
higher the patients' perception that their condition was consistent
with care at home (OR = 2.77, 95% CI: 1.08–8.62) and with their
functional well-being (OR = 1.45, 95% CI: 1.08–2.17). In addition,
the higher the caregivers' satisfaction with life (OR = 2.37, 95% CI:
1.15–5.77), the more willing patients tended to be to continue
living at home.
Significant of results: The willingness of Japanese
terminally ill cancer patients to continue living at home appears to be
affected by caregiver status. This indicates a need for discharging
facilities to monitor the state of home assistance and to investigate the
nature of assistance required for continuing home care.
Objective: Employing a nationwide cross-sectional survey, we
investigated the Japanese general population's attitudes toward
disease and prognosis disclosure and related factors. Furthermore, we
investigated Japanese medical practitioners' attitudes toward disease
and prognosis disclosure for patients and decision making.
Methods: A nationwide anonymous questionnaire survey was
conducted. A total of 5000 individuals were randomly sampled from the
general population and 3104 physicians and 6059 nurses were randomly
sampled in Japan.
Results: Finally, 2422 people from the general population
(response rate, 48%), 1577 physicians (51%), and 3361 nurses (56%)
returned questionnaires. Among the general population, 73% of participants
answered that they “want to know” about their disease and
prognosis when in an incurable disease state. Ninety percent desired
direct disclosure and 8% disclosure through their family. However, few
medical practitioners answered “patient himself” (physician
3%, nurses 4%) as the person whom they would primarily notify about the
disease and prognosis when in charge of a patient with an incurable
disease. On the other hand, physicians answered “family” most
frequently (59%), whereas nurses most commonly responded, “depends
on patient's condition” (63%).
Significance of research: Several detailed analyses of
factors associated with prognosis disclosure were conducted. Japanese
physicians need to carefully communicate with the patients individually
about whether direct disclosure or disclosure primarily to the family is
Objective: The aim of this study was to clarify the state of
pain management in Japanese patients with advanced cancer who initiated
opioid therapy in an outpatient setting.
Methods: Interview surveys using questionnaires were
conducted and medical records were reviewed. Pain relief was defined as
>33% decrease in worst pain intensity score, and significance of early
pain relief was investigated in terms of changing self-efficacy for
activities of daily living (ADL). Factors related to early pain relief
were also investigated.
Results: The study was conducted between June and December
2003, on 20 patients (13 women, 7 men; mean age, 59 years). Compared to
score at initiation of opioid administration (Numerical Rating Scale, 8.3
± 1.3), pain relief was generally insufficient at 2 weeks (early
pain relief ratio was only 42%). Patients with sufficient pain relief at 2
weeks displayed significant improvements in numerous ADL functions and
symptom-coping efficacy (p = 0.037), confirming the importance of
early pain relief. Early pain relief was associated with high frequency of
hospital visits before opioid administration and absence of sudden
excavation within the first 2 weeks.
Significance of results: Result of this study indicated
insufficient pain relief at an outpatients setting with advanced cancer
patients. In the meantime, patients had who their pain decrease after 2
weeks also had improved ADL and self-efficacy at the same time. These
findings suggest that to achieve early pain relief in an outpatient
setting, clinical staff must assess pain earlier and inform patients of
possible breakthrough pain following opioid administration and available
treatments for such occurrences.
Objective: To identify the factors associated with
difficulties encountered by nurses working in general wards in hospitals
Methods: Questionnaires including items regarding
difficulties in providing care to terminally ill cancer patients, the
existence of a mentor regarding end-of-life issues, awareness of
end-of-life issues, and demographic factors were administered to 375 staff
nurses working in general in-patient wards. Multivariate regression
analyses were employed to investigate correlations between factors.
Results: Multivariate regression analysis revealed that the
existence of a mentor for end-of-life issues was associated with fewer
difficulties in all areas other than “Knowledge and skill of
nurses.” Clinical experience was inversely related to difficulties
in “Communication with patients and families” and
“Personal issues.” Greater awareness of end-of-life issues was
related to higher difficulties in most areas.
Significance of results: The existence of a mentor was
correlated with fewer difficulties in most areas. Support by a palliative
care team might be effective in reducing difficulties experienced by
nurses and in improving care for terminally ill cancer patients. Basic
communication training undertaken sooner after registration might be also
Objective: The aim of this project was to develop an
appropriate and valid instrument for assessment by medical professionals
in Japanese palliative care settings.
Methods: We developed a Japanese version of the Support Team
Assessment Schedule (STAS-J), using a back translation method, and tested
its reliability and validity. In the reliability study, 16 nurses and a
physician who work in a palliative care unit evaluated 10 hypothetical
cases twice at 3-month intervals. For the validity study, external
researchers interviewed 50 patients with matignancy and their families and
compared the results with ratings by the nurses in the palliative care
Results: Our results with hypothetical cases were: interrater
reliability weighted κ = 0.53–0.77 and intrarater reliability
weighted κ = 0.64–0.85. In the validity study comparing nurse
evaluations and the results of interviews with patients and families,
complete agreement was 36–70%, and close agreement (±1) was
74–100%. As a whole, weighted κ were low: between −0.07
and 0.51. Our results were similar to those in the United Kingdom and
Significance of results: Although this research was conducted
under methodologically limited conditions, we concluded that the STAS-J is
a reliable tool and its validity is acceptable. The STAS-J should become a
valuable tool, not only for daily clinical use, but also for research.
Email your librarian or administrator to recommend adding this to your organisation's collection.