Search

Context Terminal dyspnea in dying cancer patients is frequent and distressing, and the impact extends to their families. Families are often involved in providing care for terminal dyspnea. Objectives This study aimed to describe various care strategies for terminal dyspnea in cancer patients hospitalized in palliative care units (PCUs), evaluate families’ satisfaction with care for terminal dyspnea, and explore determinants contributing to families’ satisfaction. Methods A nationwide, cross-sectional survey was conducted using a self-reported questionnaire among bereaved families of cancer patients who died in PCUs. The questionnaire consisted of questions on the perceptions of care offered to patients with terminal dyspnea and their families, satisfaction with care for terminal dyspnea, family-perceived intensity of terminal dyspnea, use of oxygen, and background data of patients and families. Results In total, 533 participants (response rate = 54%) returned the completed questionnaires, and 231 reported that their loved one had experienced terminal dyspnea. Dedicated and compassionate care was perceived by 60%–89% of the participants as the strategy provided for patients. Care for family members was perceived by 58%–69% of the participants. Perception of dedicated and compassionate care for patients and that of care for family members were significantly associated with high satisfaction (odds ratio, 95% confidence interval: 8.64, 3.85–19.36 and 15.37, 5.00–47.25, respectively). Conclusion Dedicated and compassionate care may be the essential part of the care for terminal dyspnea. Dedicated and compassionate care for patients and care for family members have a potential of improving the care satisfaction among family caregivers.

Objective: This study aimed to evaluate the psychometric properties of the Japanese version of the Cancer Survivors' Unmet Needs (CaSUN-J) scale among cancer survivors in Japan. Methods: The CaSUN-J was developed using standardized translation methodology. Content validity was evaluated by a group of experts, and a pilot test was conducted with a convenience sample of 10 cancer patients. A total of 183 Japanese cancer survivors completed the CaSUN-J. The internal consistency of the scale was examined with Cronbach's α. Construct validity was analyzed using correlations with the physical effects, quality of life (QoL), and age. To assess the factorial validity of the CaSUN-J, confirmatory factor analysis (CFA) was performed. Results: The CaSUN-J indicated good readability and high content validity for use as an assessment tool among Japanese cancer survivors. All Cronbach's α coefficients were above the minimum acceptable criterion of ≥0.70. For construct validity, higher physical effect scores, as well as poorer QoL scores and younger patients, were significantly positively associated with higher levels of needs. CFA indicated that the five-factor structure of the CaSUN-J was a good fit to the data. Conclusions: The CaSUN-J can serve as a valid and reliable tool to evaluate unmet needs among Japanese cancer survivors.

Despite contributing to the control of hormone receptor-positive breast cancer, a highly prevalent cancer type, endocrine therapy affects patients’ cognitive function. We aimed to identify cognitive decline following the start of endocrine therapy using patient-reported measures and investigate factors associated with cognitive difficulties. This cross-sectional survey used a self-administered, anonymous questionnaire. The participants were 876 patients with breast cancer who experienced subjective cognitive difficulties after starting endocrine therapy. Our sample was recruited from 11 patient advocacy groups, 5 clinics, and 2 hospitals in Japan. The questionnaire assessed subjective cognitive difficulties (30 items), psychological well-being, demographic and clinical information, and other subjective symptoms. Of 510 (58.2%) responses, we analyzed 405 (46.2%) questionnaires. Exploratory factor analysis identified three factors of cognitive difficulties: Factor 1, “difficulties in manipulating memory and language;” Factor 2, “difficulties in processing multiple pieces of information;” and Factor 3, “difficulties in maintaining attention and concentration.” Factor 1 was the most common type, and it was significantly related to the treatment characteristics of endocrine therapy. Multivariate logistic regression analysis revealed that fewer household members, a history of breast surgery, more severe menopausal symptoms, and greater psychological distress were significantly associated with cognitive difficulties. As cognitive difficulties increased, the proportion of participants suspected to have psychological disorders increased significantly. Patients treated with endocrine therapy for breast cancer experience intricately intertwined impairments in several domains of cognitive function. They have an increased risk of psychological disorders corresponding to the degree of subjective cognitive function.

Purpose Practicing self-care behaviors is important for patients with gastrointestinal cancer undergoing outpatient chemotherapy. Knowledge of personality traits may be useful in providing individualized support that can improve self-care behaviors. Therefore, we assessed the association between personality traits and self-care behaviors in these patients. Methods This cross-sectional study was conducted among patients who received intravenous chemotherapy at a designated regional cancer hospital between June 2020 and October 2020. A self-administered survey was conducted among these patients using the Japanese version of the Ten Item Personality Inventory and a 29-item questionnaire to assess self-care behaviors. Association between the scores of the personality traits and frequency of each self-care behavior was analyzed using the Spearman's rank correlation coefficient. Results In total, 53 responses were obtained from 57 participants, of which 52 valid responses were included in the analysis. Openness and conscientiousness were personality traits significantly associated with multiple self-care behaviors. High degree of openness, characterized by the ability to tackle new situations, had a moderately significant positive correlation with adjustment of exercise (ρ = 0.49, pρ = 0.40, pρ = 0.30, p=0.03) and confirmation of inspection results (ρ = 0.39, p

The global understanding of cancer survivorship care leads to optimal care delivery for cancer survivors. This study aimed to assess the perceptions of Japanese oncology nurses regarding cancer survivorship care and explore the factors influencing the provision of survivorship care.A questionnaire survey of oncology nurses was conducted as part of a multinational, cross-sectional survey. A 29-item measurement scale with four subscales regarding survivorship care was used to assess nurses' perceptions regarding responsibility, confidence, and frequency of practice for cancer survivors. Additionally, we investigated a list of 16 factors influencing the provision of survivorship care.Among 181 oncology nurses, the mean adjusted scores for survivorship care items were 65.6-84.7, 16.8-44.7, and 29.2-47.2 for responsibility, confidence, and frequency, respectively. Significant correlations were observed in the subscales for frequency of care with responsibility (Oncology nurses face many challenges regarding survivorship care, even though they recognize their responsibility. Educational support for oncology nurses is warranted to overcome impeding factors and improve confidence.

Decision making regarding the place of end-of-life (EOL) care is an important issue for patients with terminal cancer and their families. It often requires surrogate decision making, which can be a burden on families.To explore the burden on the family of patients dying from cancer related to the decisions they made about the place of EOL care and investigate the factors affecting this burden.This was a cross-sectional mail survey using a self-administered questionnaire. Participants were 700 bereaved family members of patients with cancer from 133 palliative care units in Japan. The questionnaire covered decisional burdens, depression, grief, and the decision-making process.Participants experienced emotional pressure as the highest burden. Participants with a high decisional burden reported significantly higher scores for depression and grief (both P 0.001). Multiple regression analyses revealed that higher burden was associated with selecting a place of EOL care that differed from that desired by participants (P 0.001) and patients (P = 0.034), decision making without knowing the patient's wishes and values (P 0.001) and without participants sharing their wishes and values with the patient's doctors and/or nurses (P = 0.022), and making the decision because of a due date for discharge from a former facility or hospital (P = 0.005).Decision making regarding the place of EOL care was recalled as burdensome for family decision makers. An early decision-making process that incorporates sharing patients' and family members' values that are relevant to the desired place of EOL care is important.

Saving lives is the first priority in emergency departments. However, it is important to provide end-of-life care (EOLC) for patients and their families in these departments when the patient's life cannot be saved. Existing work reporting the obstacles and difficulties of nursing practice has found that the perceptions of nurses who provide EOLC include distress and conflict. The primary aims of this study were (i) to clarify the structure of the conflict experienced by nurses providing EOLC in emergency departments and (ii) to explore factors influencing this experience of conflict. A questionnaire survey was conducted among nurses working in emergency departments in Japan. The participants were sampled using a random sampling design. In total, 290 (55.3%) nurses responded to the survey and 288 (55.0%) responses were usable for the analysis. Seven components comprising 31 items were identified: (1) conflict about ability to practice EOLC; (2) conflict about relationships with the medical team; (3) conflict about the environment for EOLC; (4) conflict about decision making; (5) conflict about family nursing; (6) conflict about patients' pain; and (7) conflict about medical limitations. The nurses' individual backgrounds and support systems were found to influence their experience of conflict. To support nurses providing EOLC in emergency departments, we need to understand the conflict they experience, including how their backgrounds affect this experience, and construct a system that incorporates support from the specialized field of EOLC.

Objective: The present study aims to describe fall-related self-efficacy as perceived by patients with chemotherapy-induced peripheral neuropathy (CIPN). The characteristics of patients associated with low perceived self-efficacy of preventing falls were investigated. Methods: A cross-sectional study of four hospitals in Japan. In this study, 100 outpatients who were receiving chemotherapy for cancer and experiencing CIPN were recruited. Participants completed an anonymous, self-administered questionnaire. Self-efficacy was measured with the falling self-efficacy (FSE) scale, and the severity and impact of CIPN was assessed with the Comprehensive Assessment Scale for CIPN in Survivors of Cancer (CAS-CIPN). Data about the demographic information of the patients, cancer diagnosis and treatment, pain and fatigue symptoms, and history of previous falls were collected. Logistic regression analysis was used to assess relationships between variables. Results: A total of 81 (81.0%) participants with CIPN completed the questionnaire. They reported experiencing fear of falling during their daily activities, which include the act of standing up, walking, and using the stairs. Small events, such as unstable postures and uncomfortable situations, affected their confidence of preventing falls. Logistic regression revealed that low FSE scores were significantly associated with female sex (P = 0.022), low body mass index (BMI; P = 0.026), and the CAS-CIPN score (P < 0.001). Conclusions: Female patients with CIPN and low BMI might have an increased need for enhanced fall-related self-efficacy. A comprehensive assessment of CIPN in patients at risk of low FSE scores is likely to be beneficial.

Introduction End-of-life care (EOLC) is necessary for patients who are not expected to live long. Nurses have positive attitudes toward EOLC, but they encounter difficulties in practice. That situation creates conflict, which can affect burnout. It is essential to manage nurses’ conflict about their ability to practice EOLC by enhancing their individual strengths. Focusing on the role of self-compassion may help to prevent burnout related to the conflict about ability to practice EOLC. Objective The study aim was to assess the mediating effect of self-compassion on the association between conflict about ability to practice EOLC and burnout. Methods A correlational study was conducted with emergency department nurses who practiced EOLC. Self-report measures of conflict about ability to practice EOLC, burnout, and self-compassion were obtained. Results Negative aspects of self-compassion mediated the relationship among conflict, emotional exhaustion, and depersonalization (burnout). Self-compassion did not mediate the association between conflict and reduced personal accomplishment (burnout). Conclusions Negative aspects of self-compassion mediated the relationship between conflict and burnout (excluding reduced personal accomplishment). To prevent burnout, it is necessary to screen for nurses with low self-compassion and to provide opportunities to change their cognitive recognition and disclose their conflicts.

While more women with breast cancer survive because of advances in cancer treatment including hormonal therapy, they are at a risk of menopausal symptoms, which can threaten their psychological wellbeing. We examined the effect of menopausal symptoms on women's psychological wellbeing during three different phases of breast cancer: short-term (0-1 years since diagnosis), medium-term (2-5 years), and long-term (more than 5 years). In this cross-sectional study, 425 survivors treated with hormonal therapy were recruited from a convenience sample in Japan and completed an anonymous self-administered questionnaire. Multiple regression analysis revealed that menopausal symptoms significantly contributed to psychological wellbeing in all phases. In long-term survivors, menopausal symptoms were significantly milder; however, the negative effect was prolonged. One in three to four survivors was suspected to have poor psychological wellbeing, irrespective of time. Although the effect of menopausal symptoms on psychological wellbeing has been described in short-term survivors, little is known about the long-term effect. This study examines the effect of menopausal symptoms on psychological wellbeing, thereby providing useful information regarding long-term quality of life.

Objective This study was performed to clarify the influence of financial conditions on stress in patients with advanced recurrent colorectal cancer undergoing outpatient chemotherapy. Methods A self-administered questionnaire survey was completed by patients with advanced and recurrent colorectal cancer receiving outpatient chemotherapy in five hospitals in the Kansai region. The questionnaire included basic information (age, sex, current employment availability, and subjective financial condition (3 choices)), and the 29-item stress scale from Japanese version of the Mastery of Stress Instrument (5-point scale with a total score of 29-140 points) . Results Responses were received from 76 outpatients (response rate: 95%). The patients’ mean age was 66.6 ± 8.5 years, and they comprised 50 men (65.8%) and 26 jobholders (34.2%). Three patients (3.9%) always had financial leeway (Yutori group), 37 (48.7%) had a satisfactory financial margin (sufficient group), and 36 (47.4%) had no financial margin (marginless group). The mean stress score was 70.0 ± 15.3 points. The stress score was significantly higher in the unemployed group than in the working group. With respect to the patients’ subjective financial condition, the stress score was significantly higher in the marginless group than in the sufficient group. The Yutory group did not differ significantly from any other groups. Discussion and Conclusion Patients with advanced recurrent colorectal cancer undergoing outpatient chemotherapy often follow a long-term treatment course. Therefore, financial problems while undergoing cancer treatment may be a heavy burden. Patients who are unemployed and have no income appear to experience stressful conditions during treatment, such as distress and confusion. These findings suggest the need to provide both mental support and employment support to patients undergoing treatment for cancer. This work was supported by KAKENHI Grant Number A16H055760.

Unfinished business often causes psychological issues after bereavement. Providing care for families of terminally ill patients with cancer to prevent unfinished business is important.To clarify the prevalence and types of unfinished business in families of end-of-life patients with cancer admitted to palliative care units (PCUs), explore depression and grief associated with unfinished business, and explore the factors affecting unfinished business.We conducted a cross-sectional, anonymous, self-report questionnaire survey with 967 bereaved families of patients with cancer admitted to PCUs. The questionnaire assessed the presence or the absence of unfinished business, content of unfinished business, depression, grief, process of preparedness, condition of the family and patient, and the degree of involvement of health care professionals.Questionnaires were sent to 967 families, and 73.0% responded. In total, 26.0% of families had some unfinished business, with improvement of the patient-family relationship being a common type of unfinished business. Families with unfinished business had significantly higher depression and grief scores after bereavement compared with those without. Factors that influenced the presence or the absence of unfinished business were preparedness for the patient's death (P = 0.001), discussion between the patient and family about the disease trajectory and way to spend daily life (P 0.001), good patient-family relationship (P = 0.011), and family and health care professionals considering together the appropriate timing to accomplish the family's wishes (P = 0.021).Many families have unfinished business. Health care professionals should coordinate the appropriate timing for what the family wishes to do, with consideration of family dynamics, including the family's preparedness, communication pattern, and relationships.

【目的】治療期にある通院中のがん患者を対象に, セルフケア能力を向上させる看護独自の介入プログラムを開発することを目的とした.【方法】参加者15名を対象に, 4週連続の複合的グループ療法を実施し効果検証を行った.【結果】参加者の概要は, 平均年齢56.86±11.52歳, 現病歴平均28.6±18.14カ月であった. 介入前後で, EORTC QLQ-C30 Global health status (p

本研究の目的は、2004年に本研究プロジェクトが作成した災害時版患者用パンフレットを検討することである。調査は、Web上での研究協力の呼びかけに賛同した33名を対象として、筆者らが作成したパンフレットを洗練するための構成的質問と自由記載によるデータ収集をWeb上で行った。データ分析は、構成的質問については記述統計を、自由記載内容についてはカテゴリー化を行い、分析した。その結果、絵や文字の大きさの適切さについては、19人(58%)が「適切である」と回答し、13人(39%)が「まあまあ適切である」と回答していた。表現の適切さについては、「適切である」という回答が18人(55%)、「まあまあ適切である」という回答が14人(42%)であった。また、実際の生活に対する有用性に関しては、19人(58%)の回答者が「実際に使えそうだ」と答えていた。絵や文字の大きさ、表現の適切さ、実際の生活に関する有用性については、いずれも32人(97%)が適切、まあまあ適切・実際に使えそうだと回答しているが、量の適当さについては、「適当である]という回答が19人(58%)、「多い」と回答した人が14人(42%)であった。また、パンフレットで役に立つ情報は、災害時に自己対処する方法・食事に関する情報・災害に備えたがん療養中の自己管理の方法・化学療法に関する知識・その他に分類された。以上の結果から、パンフレットの量については改善の必要性が示唆されたが、その他の表面妥当性については概ね適切であった。パンフレット中の役立つ情報として、災害時に自己対処する方法や災害に備えたがん療養中の自己管理法が上位に挙げられたことは、「がん患者のセルフケア能力を高める」ことに本パンフレットが活用できることを示唆していた。, The study aimed to evaluate the Care Package for Cancer Patients during Disaster situations, developed in 2004 by the Cancer Nursing Group. Studied were 33 people who agreed to a request seeking cooperation with the study online. The study involved questionnaires consisting of structured and open-ended questions online, designed by researchers to get feedback from participants in order to consider the care package. Participants' responses to structured questions were analyzed using descriptive statistics from closed-ended questions; comments on evaluation of the care package were categorized. As a result, regarding appropriateness of character and illustration size, 19 (58%) answered "appropriate" and 13 (39%) answered "reasonably appropriate." Regarding terminological and idiomatic appropriateness, 18 (55%) answered "appropriate" and 14 (42%) answered "reasonably appropriate." Regarding usefulness in actual life, 19 (58%) responded "seems useful" and 13 (39%) responded "seems relatively useful." As noted above, 32 (97%) responded positively ("appropriate," "reasonably appropriate," "seems useful," "seems relatively useful") to the three questions regarding appropriateness of the illustration/character size, terminology, and usefulness in actual life. Regarding appropriateness of the volume of information provided, 19 (58%) answered "appropriate," but 14 (42%) answered "too large." Useful information in the pamphlets was classified into the following categories: information on coping with specific situations themselves during disasters; information on eating during cancer treatment; information on self-management in cancer treatment during disaster preparation; knowledge regarding chemotherapy I and others. Although the survey results indicated the necessity for improvement in terms condensation of volume, they also indicated that the care package was rated "appropriate" overall. The fact that 'information on coping with specific situations themselves during disasters' and 'information on self-management in cancer treatment during disaster preparation' ranked high as useful information suggests the pamphlets can be used to help cancer patients improve their self-care skills and abilities, as originally intended by the Cancer Nursing Group.

本研究では、がん医療を担う施設において、外来通院治療を受けているがん患者が、災害時に治療を継続するためのシステムと災害への備えを明らかにし、その上で、外来通院治療を受けているがん患者が治療を継続できるシステムのあり方について提示することを目的とした。近い将来に災害が起きることを想定して対策を講じている地域がん診療拠点病院をはじめとする5つの医療施設において、災害対策に詳しい担当者12名を対象に、外来通院治療を受けているがん患者が、災害時に治療を継続するためのシステムの内容と、施設における災害への備えの内容について、1時間程度のヒヤリング調査を実施した。その結果、災害時に継続治療を必要とする外来患者を把握するシステムや、災害時に外来化学療法を受けている患者や麻薬を使用している患者の治療継続のためのシステムを備えている施設けなかった。しかし、ヒヤリング結果より、災害時のシステムとしては確立されていないが、平常時のシステムを活用し、災害時に継続治療の必要な患者を把握することが可能な手段・方法として、(1)平常時に各専門職が得る患者情報を使用して患者を把握する、(2)電子情報媒体を使って患者を把握する、(3)診療記録や名簿等の紙媒体から患者を把握する、という3つのルートが考えられるということが明らかになった。また、今後は、がん診療連携拠点病院制度のネットワークを生がし、がん専門病院として、災害時も、がん治療の拠点として期待できることが考えられるとともに、災害時に外来化学療法を受けている患者や麻薬を使用している患者の治療継続については、患者・家族のセルフケア能力を高めておくことが必要であることが示された。, This study aimed to clarify the systems and disaster preparedness that are in place at health care facilities involved in cancer treatment to ensure that cancer patients receiving outpatient treatment can continue receiving treatment during a disaster, and to propose appropriate systems for ensuring continuation of treatment for cancer outpatients in times of disaster. In this study, interviews were conducted in five medical facilities that take precautionary measures in preparation for possible disasters in the near future, including a regional hub hospital for cancer treatment. Twelve people in charge of disaster preparedness and response were interviewed for approximately one hour about what system is in place at their respective hospitals to allow cancer outpatients to continue their treatment during a disaster and about how their hospitals prepare for disasters. The interviews revealed that the hospitals studied had no system in place to identify patients who need to continue treatment during a disaster, or to ensure that cancer patients receiving outpatient chemotherapy or taking pain medicines can continue receiving treatment or medication. It was also revealed that, though there was no system specifically designed for use in disaster situations, it was possible to identify patients who needed to continue receiving treatment during a disaster by using the system employed during ordinary times in the following three ways: (1) using patient information acquired in ordinary times through health care professionals; (2) using electronic information media; and (3) using information stored on paper media such as medical records and name lists. The interview survey suggests that it can be expected that cancer specialist hospitals can serve as centers for cancer treatment in times of disaster by forming a network of cancer care hub hospitals. It is also suggested that it is necessary to improve self-care skills and abilities of cancer patients and their families to ensure that cancer patients receiving outpatient chemotherapy and taking pain medicines can continue their treatment/medication during a disaster.

Aim: The purpose of the study was to identify the actual circumstances of treatment and nursing care for cancer patients during a time of disaster. Methods: The study subjects were 17 nurses working in eight institutions who engaged in nursing activities for cancer patients in the wake of the 1995 Hanshin-Awaji Earthquake at hospitals located in and around the stricken areas. The data were collected through focus group interviews and were analyzed by inductive and qualitative methods to categorize needs. The results were compared with the data categorized by Knowledgeocean, a text-mining tool for analyzing unstructured text in order to examine data validity. Results: The actual circumstances of the treatment and nursing care of cancer patients in disaster situations were divided into three major categories and 10 subcategories. The major categories were: “difficulty in keeping track of patients” undergoing outpatient treatment, “adjustment in treatment” in an effort to continue various therapies for cancer treatment, and “care for patients and their families before and after the last moment” in the case of terminally ill patients. Conclusions: The results suggest that the following issues should be addressed in the future: the need for an information management system for the resumption of interrupted treatment and the transportation of patients, the need for enhancing the self-care ability of cancer patients in ordinary situations so that they can be more self-sufficient in disaster situations, and the need for the creation of a suitable location for dying patients and their families and the development of grief care strategies in disaster situations.

Aim: The aim of this study is to develop a care package to help cancer patients improve their self-care abilities and better prepare for a disaster, so that they can continue treatment and perform symptom management strategies in disaster situations. Methods: In this study, the “Care Package for Cancer Patients in Times of Disaster”, which comprises four pamphlets, was developed through discussions among the eight members of the study group. The care package was produced by making additions and modifications, based on the findings obtained in the above two steps, to the patient education booklets developed in the area of oncology. Results: Of the areas that cancer patients find difficult in times of disaster, the following six were extracted: difficulty in continuing treatment, the possibility of running out of pain medicines and how to store pain medicines, the possibility of not being able to go to a regular hospital, the shortage of stoma-care appliances and other products, the possibility of exposure to infections at a shelter, and the necessity of providing care for cancer patients and their families before and after death. By incorporating these pieces of information, we developed the four pamphlets. These pamphlets are posted on the website for public use. Conclusion: The newly developed pamphlets incorporate information on how to cope with specific situations in times of disaster, based on the findings obtained from the “Survey on Actual Conditions of Treatment and Nursing Care to Cancer Patients in Disaster Situations”.

While more women with breast cancer survive because of advances in cancer treatment including hormonal therapy, they are at a risk of menopausal symptoms, which can threaten their psychological wellbeing. We examined the effect of menopausal symptoms on women's psychological wellbeing during three different phases of breast cancer: short-term (0-1 years since diagnosis), medium-term (2-5 years), and long-term (more than 5 years). In this cross-sectional study, 425 survivors treated with hormonal therapy were recruited from a convenience sample in Japan and completed an anonymous self-administered questionnaire. Multiple regression analysis revealed that menopausal symptoms significantly contributed to psychological wellbeing in all phases. In long-term survivors, menopausal symptoms were significantly milder; however, the negative effect was prolonged. One in three to four survivors was suspected to have poor psychological wellbeing, irrespective of time. Although the effect of menopausal symptoms on psychological wellbeing has been described in short-term survivors, little is known about the long-term effect. This study examines the effect of menopausal symptoms on psychological wellbeing, thereby providing useful information regarding long-term quality of life.

Dramatic advances have been made in cancer treatment in recent years, enabling patients to leave the hospital more quickly and stay home while still undergoing treatment. As a result, the percentage of outpatients has been on the rise. Healthcare providers engaged in actual outpatient treatment, however, spend so much energy implementing daily procedures safely that they have little time remaining to provide patient education or carry out any other systematic patient support programs. Although self-care generally is believed to be what people do to help themselves, differences exist between Western countries and Japan in the interpretation of self-care. In Japan, obtaining necessary support from the family and friends that one relies on also is viewed as essential. Patients' self-care agency must be assessed if nurses are to make the most of patients' abilities; however, evaluation criteria for that purpose have yet to be established. Development of a method for evaluating the self-care agency of patients receiving chemotherapy on an outpatient basis is needed to ensure further advancement in this area of nursing.

With the aim of preparing for disasters, care information packages for the support of patients with cancer and their families during disaster situations were developed in our previous study, and were provided via the internet with a questionnaire asking the face validity and the usefulness of such information. Thirty replies were received. Most subjects thought the care packages were appropriate and useful in the actual settings, however 43.3% of them thought the amount of information was excessive. Many comments and suggestions on the care information packages also could be obtained via the internet.