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ObjectiveEnd-of-life experiences (ELEs), such as deathbed visions (DBVs), have been reported worldwide. However, ELEs have rarely been discussed in clinical practice, possibly because of the different perceptions of ELEs among clinicians and families. Therefore, this study aimed to investigate the differences in perception regarding ELEs, especially DBVs, between clinicians and families.MethodsWe conducted a multicentre, prospective and observational study with patients with cancer. After the patients’ death, clinicians recorded their perceptions of patients’ ELEs during the palliative care unit admission, and bereaved families responded to a questionnaire about ELEs. The primary outcome was the frequency and concordance of DBVs from the perspective of bereaved family members and clinicians. The second outcome was each group’s frequency of terminal lucidity and terminal coincidence.ResultsThe study included 443 patients. DBVs were reported more frequently by family members than clinicians (14.0% vs 2.7%, pConclusionsClinicians and family members may perceive ELEs differently. Enabling patients and their families to talk about ELEs would assist in optimising grief care.

ObjectivesVoluntarily stopping eating and drinking (VSED) could be regarded as a patients’ own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED.Methods219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016.ResultsA total of 571 (62%) responses were analysed. A total of 185 (32%) had experience of patients who selected VSED. In response to questions about CDS to provide relief to patients during VSED, the number of physicians who replied that CDS was acceptable was 88 (15%).ConclusionsIn Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.

Background Education of Advance Care Planning facilitators who support decision-making in difficult end-of-life medical decisions is important. Aim The objective of this study is to identify the benefits of such an educational program. Methods In June 2014, a training course was held using the educational program (supported by Grants-in-Aid for Health Labour Scientific Research) targeting a group of 19 members, made up of nurses, medical social workers, and doctors. Before and after the training course, a survey questionnaire using Frommelt Attitude Toward Care Of Dying scale-Form B-Japanese version was executed to evaluate the quantitative variations. After the training course, a focus group interview (FGI) was held to qualitatively evaluate the “experience of the training session”. Results In the survey questionnaire, 18 individuals were targeted and in comparing before and after the training session, there were visible improvements on the overall scale as well as the various subscales of “positive attitude toward care of dying patients”.(p = 0.0372, 0.0032). In the FGI targeting 12 individuals, points such as “increase in eliciting communication with the application of ethical principles in order to adjust between the varying ideas due to difference in values” were extracted from the content analysis. Discussion This research is the first to address the short term results of the Japanese version Advance Care Planning facilitator education program. Conclusion Japanese version Advance Care Planning facilitator education program is useful.

Background Geriatric health services facilities (GHSF) play important roles as intermediary institutions by providing rehabilitation, nursing, and daily care services for elderly individuals prior to returning home from the hospital. However, the number of residents who spend their end of life in the facilities is increasing. Aim To clarify current status of end-of-life care discussions (EOLD) in GHSF in Japan. We also analysed factors related to the facilities which provided EOLD prior to life threatening health deterioration. Methods We conducted a nationwide cross-sectional survey by mailing questionnaires about end-of-life care and EOLD to 3437 managing directors of GHSF in 2012. Results The response rate was 20.7% (n = 713), of which 521 (73.1%) provided discussion about end-of-life care. Among those 521 facilities, 304 (58.3%) conducted EOLD with residents and family members after life threatening health deterioration, whereas 199 (38.2%) held those prior to health deterioration. Several factors were statistically significant for introduction of EOLD before health deterioration including education of EOLD for care workers and nurses, availability of doctors in emergencies, private rooms provided for critically ill residents, and accumulated experience based on the average number of residents who died while receiving care at the facility. Discussion/conclusion This is the first nation-wide survey regarding EOLD in GHSF in Japan. Adequate practical staff education program of end-of-life care and EOLD may be crucial for quality end-of-life care in GHSF in Japan.

Objective To examine the current status and physicians9 attitude toward ACP in PCU in Japan. Method We conducted a questionnaire survey and retrospective chart review of 203 certified PCU in December 2010. We received permission to perform a retrospective chart review of ACP before and during admission, and who made the decision to admit a patient into the hospice palliative care program for the last 3 patients who died before 30 November 2010 in each PCU. Physicians working in the PCU were asked to complete a questionnaire regarding their attitude toward, and practice of ACP. Main results Among 203 PCUs contacted, 95 participated (response rate 47%). 285 patients were reviewed. The percentage of patients for whom their physicians expressed their intentions regarding implementation of CPR, mechanical ventilation, antibiotics, tube feeding, artificial hydration and Power of Attorney of health care prior to admission to PCU was 44%, 44%, 9%, 15%, 29% and 41% respectively. However during their admission this increased to 47%, 46%, 19%, 18%, 43% and 49% respectively. 70% of patients had a physician9s order to implement DNAR and 44% of families consented to implementation of the DNAR order without discussing the issue with the patient. We also assessed physicians9 attitudes toward and practice of ACP. Conclusions This study will clarify the current status of and physicians9 attitude toward ACP in PCU in Japan, and provide evidence of the unique cultural diversity toward end-of-life care and ACP among Japanese.

The aim of this study is to examine physicians9 attitude toward ACP in PCU in Japan. We conducted a questionnaire survey to responsible physicians who worked in 203 certified PCU in December 2010. We asked them to complete a questionnaire regarding their attitude toward, and practice of ACP. We used 15 items questionnaire adopted from previous research (Davidson K, JAMA 1989) to investigate physician9s attitude toward ACP. The questionnaire was confirmed its content validity by conveniently sampled 10 palliative care specialists. Among 203 physicians contacted, 95 returned the questionnaire (response rate 47%). The percentage of physicians who practicing ACP discussion during admission in PCU regarding implementation of CPR, existing Advance Directives (ADs) and Power of Attorney of health care was 33%, 46% and 40 % respectively. Responses to attitude statements were similar to US study in 1987 except for following three statements; “In a catastrophic situation, I would have greater confidence in my treatment decisions if guided by an AD”, “Widespread use of ADs could help contain medical expenditure” and “Widespread acceptance of ADs will lead to less aggressive treatment even of patients who do not have an AD” (34.4%, 31.4% and 28.6% of Japanese physicians answered agree or strongly agree V.S. 70.9%, 74.1% and 61.2% of US physicians). This study will clarify physicians9 practice and attitude toward ACP in PCU in Japan, and provide evidence of the unique cultural diversity toward end-of-life care and ACP among Japanese.