Maho Aoyama

【目的】宮城県におけるグリーフケア，グリーフサポート情報に関する情報源，ひと目で把握できる情報源が存在しなかったため，県内の関連団体を可視化することを目的とした．【活動の概要】任意団体「東北グリーフサポート」を発足し，仙台・宮城グリーフサポートマップを作成した．また，市民公開講座およびグリーフ・フェスを開催し，一般市民を対象に認知度やニーズ調査を行った．【成果】市民公開講座参加者80名のうち20%がグリーフケア受療経験を有し，92%がマップを周囲に紹介したいと回答した．グリーフ・フェス参加者240名中，87.1%がグリーフへの理解が深まったと回答した．マップ作成とイベント開催を通し，県内における関連団体ネットワークが形成された．【結論】本活動により，県内のグリーフ関連資源を可視化でき，支援を必要とする市民が適切な支援へつながる可能性が示された．

Aim This study aimed to clarify the end-of-life care among inpatients with schizophrenia, using a national claims database. Methods We conducted a retrospective cohort study of inpatients aged 20 years and older who died between 2012 and 2015, using a sampling dataset of the National Database (NDB) of Japan. The outcome was the proportion of patients who received end-of-life care in the last 14 days of life. Results We analysed data from 49 932 end-of-life patients, 530 of whom had schizophrenia. Regarding the place of death, patients with schizophrenia died in psychiatric units (44.8% (95% CI 41.7 to 48.9)). A lower proportion of patients with schizophrenia received cardiopulmonary resuscitation (CPR) (16.6% vs 20.5%, pConclusion This study revealed the place of death and the provision of high-intensity end-of-life care for inpatients with schizophrenia, utilising the NDB of Japan.

Background: Satisfying patients’ preferences is an important outcome in palliative care. Previous research has reported that a patient’s place of death was associated with quality of death and dying. Purpose: This study aimed to evaluate the association between the congruence between a patient’s preferred and actual place of death and their quality of death and dying, as perceived by their family caregivers. Method: Data were obtained from a nationwide cross-sectional questionnaire survey of bereaved family caregivers of patients with cancer in Japan. A total of 13,711 family caregivers participated. We evaluated the quality of death and dying using the Good Death Inventory. Results: 9,123 responses were analyzed (effective response rate: 67%). Patients who died in their preferred place were categorized as the “achieved group,” whereas patients who died in a place that they did not prefer were classified as the “not-achieved group.” Good Death Inventory scores were significantly higher for the achieved group compared with the not-achieved group (48.8 ± 10.1 and 44.0 ± 9.5, respectively; p < 0.001). A multiple linear regression analysis indicated that congruence between the preferred and actual place of death was an independent determinant of good quality of death and dying (p < 0.001). Conclusion: Congruence between a patient’s preferred and actual place of death may contribute to better quality of death and dying among terminally ill patients with cancer. Congruence between the preferred and actual place of death should be regarded as an essential component in end-of-life care.

Background: Satisfying patients’ preferences is an important outcome in palliative care. Previous research has reported that a patient’s place of death was associated with quality of death and dying. Purpose: This study aimed to assess factors associated with congruence between a patient’s preferred and actual place of death and their quality of death and dying, as perceived by their family caregivers. Method: Data were obtained from a nationwide cross-sectional questionnaire survey of bereaved family caregivers of patients with cancer in Japan. A total of 13,711 family caregivers participated. We evaluated the quality of death and dying using the Good Death Inventory. Results: Patients who died in their preferred place were categorized as the “achieved group,” whereas patients who died in a place that they did not prefer were classified as the “not-achieved group.” Survey scores were significantly higher for the achieved group compared with the not-achieved group (48.8±10.1 and 44.0±9.5, respectively; p <0.001). A multiple linear regression analysis indicated that congruence between preferred and actual place of death was an independent determinant of good quality of death and dying (p <0.001). Conclusion: Congruence between a patient’s preferred and actual place of death may contribute to better quality of death and dying among terminally ill patients with cancer. Congruence between preferred and actual place of death should be regarded as an essential goal in end-of-life care.

Background: Maintaining quality of care and improving the quality of life (QOL) of patients and their families are important issues in palliative care. Therefore, there is a need to continuously evaluate the quality and outcomes of the care provided. In Japan, the Japan hospice and palliative evaluation (J-HOPE) study series has been conducted every three to four years since 2010, and we will conduct the fifth J-HOPE study (J-HOPE5). In the present paper, we describe the protocol of the J-HOPE5 study. The main objectives are: (1) to evaluate the processes, structures and outcomes of care at hospices or palliative care units; (2) to examine bereaved family members’ self-reported psychosocial condition, such as grief and depression as bereavement outcomes; (3) to provide data to ensure and improve the quality of care provided by participating institutions via feedback based on the results from each institution; and (4) to provide clinical and academic information regarding the implications of various issues in palliative care by conducting specific research. Methods: We will conduct a cross-sectional, anonymous, self-reported questionnaire survey. In total, 153 institutions have agreed to participate in this study, meaning that approximately 12,240 bereaved family members (n = 80/institution) will be sent a questionnaire. Discussion: This is one of the largest cross-sectional bereavement surveys to evaluate the quality of specialized palliative care for patients with cancer, both in Japan and worldwide. The large sample size of this study will enable wide analyses of specific targets and topics.

Objectives: Insufficient preparedness for bereavement can affect a family's psychological health status after bereavement. However, factors associated with preparedness remain unclear. This study aimed to identify factors associated with preparedness for bereavement in families of patients with cancer.Methods: We conducted a secondary analysis of a nationwide bereaved family survey in Japan, analyzing data from 9123 family members of patients with cancer. Logistic regression analysis was conducted to explore how sociodemographic factors, health status, and perceived care for patients and families were associated with preparedness for bereavement.Results: Of the 9123 families, 1338 (15.1%) were not prepared for bereavement. Factors associated with insufficient preparedness for bereavement (all p < 0.001) were found as follows: patients' spouses (OR = 2.54), receiving care in acute hospitals (OR = 1.83), worse psychological health status during caregiving (OR = 2.13), lower social support for family members (OR = 1.90), wrong patients' awareness of medical condition from family's perspective (OR = 1.75–2.12), family preference of more aggressive treatment rather than palliative care (OR = 1.71) or not sure (OR = 2.31), not wanting to know information about the patient's prognosis (OR = 1.64–1.77), end‐of‐life discussion with physician 1 month before patient's death (OR = 1.45), and late or early end‐of‐life discussions with physician and family (OR = 1.78–1.95).Conclusions: This study's results might assist clinicians in assessing and identifying families who are not prepared for bereavement; however, preparedness for bereavement may have been associated with other factors.

【目的】緩和ケアの包括的な評価尺度であるIntegrated Palliative care Outcome Scale（IPOS）の非がん患者への適用を検討する．【方法】非がん患者と患者をケアする医療者, 各20名にIPOSの調査票へ回答してもらい，その調査票に対するコグニティブインタビューを行った．インタビュー内容は，質的分析手法である内容分析を用いて分析した．【結果】患者・医療者ともに約半数から9割がIPOSの全17項目に対して答えづらさやわかりにくさを感じなかったと回答し，表面的妥当性が確認された．また，分析結果を専門家で検討し，IPOSの内容的妥当性が確認され，非がん患者に特徴的なIPOSの項目も明らかになった．【結論】非がん患者に対するIPOSの表面的・内容的妥当性が確認され，IPOSは非がん患者の緩和ケアの包括的な評価ツールとして活用できることが明らかになった．