Using the Ministry of Health, Labour and Welfare national data on perspectives toward medical care at the end of life, this study examined the current status of engagement in advance care planning (ACP) activities among physicians and nurses in Japan and associated factors. Only 28.7% of physicians and 27.6% of nurses answered that they were engaging their patients/clients in ACP. Multinomial regression analysis revealed that more frequent involvement in caring for dying patients was associated with ACP engagement for both physicians and nurses. Increased years of clinical practice experience and working in a hospital were associated with decreased likelihood of nurses’ ACP engagement. Completion of training designed to promote patient self-determination at the end of life was associated with both physicians’ and nurses’ ACP engagement. It is recommended that health care professionals be encouraged to complete such training to promote patients’ autonomy through ACP.

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Background The COVID-19 pandemic has caused home health care workers (home-HCWs) to experience anxiety. The mental health of home-HCWs and related factors during the COVID-19 pandemic have not been clarified; therefore, we aimed to investigate the status and associated factors of fear of COVID-19 infection, anxiety, and depression among home-HCWs in Japan. Methods We conducted a multicenter cross-sectional web-based anonymous survey of home-HCWs in August 2021, during the fifth wave of the pandemic in Japan. We surveyed members of facilities that provided home visit services during the COVID-19 pandemic. We measured the Japanese version of the Fear of COVID-19 scale (FCV-19S-J) and the Hospital Anxiety and Depression scale (HADS) as objective variables, and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II (J-AITCS-II) as an explanatory variable. Results A total of 328 members of 37 facilities responded to the survey, and we ultimately analyzed 311 participants. The most frequent occupation was nurse (32.8%), followed by doctor (24.8%) and medical office staff (18.0%). The mean score of the FCV-19S-J was 16.5 ± 5.0 (7.0 – 31.0), and the prevalences of definitive anxiety and depression were 7.4% and 15.7%, respectively. Multivariate regression analysis revealed that the J-AITCS-II teamwork subscale was significantly negatively associated with FCV-19S-J, HADS-anxiety, and HADS-depression (β = -0.171, p = 0.004; β = -0.151, p = 0.012; β = -0.225, p < 0.001, respectively). Medical office staff showed significant positive associations with FCV-19S-J and HADS-depression (β = 0.219, p = 0.005; β = 0.201, p = 0.009, respectively), and medical social workers with HADS-anxiety and HADS-depression (β = -0.166, p = 0.011; β = -0.214, p < 0.001, respectively) compared with doctors. The unmet support need for expert lectures on COVID-19 was significantly positively associated with FCV-19S-J (β = 0.131, p = 0.048), and the unmet support need for support systems for psychological stress and emotional exhaustion was significantly positively associated with HADS-anxiety (β = 0.141, p = 0.022). Conclusions Fear of COVID-19 infection and depression of nurses, medical office staff, and other occupations was significantly higher than those of doctors. These findings suggest that non-physicians were more likely to be fearful and depressed during the COVID-19 pandemic; thus, it is necessary to tailor mental health support based on occupation in the home care setting.

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Objective Several studies supported the usefulness of “the surprise question” in terms of 1-year mortality of patients. “The surprise question” requires a “Yes” or “No” answer to the question “Would I be surprised if this patient died in [specific time frame].” However, the 1-year time frame is often too long for advanced cancer patients seen by palliative care personnel. “The surprise question” with shorter time frames is needed for decision making. We examined the accuracy of “the surprise question” for 7-day, 21-day, and 42-day survival in hospitalized patients admitted to palliative care units (PCUs). Method This was a prospective multicenter cohort study of 130 adult patients with advanced cancer admitted to 7 hospital-based PCUs in South Korea. The accuracy of “the surprise question” was compared with that of the temporal question for clinician's prediction of survival. Results We analyzed 130 inpatients who died in PCUs during the study period. The median survival was 21.0 days. The sensitivity, specificity, and overall accuracy for the 7-day “the surprise question” were 46.7, 88.7, and 83.9%, respectively. The sensitivity, specificity, and overall accuracy for the 7-day temporal question were 6.7, 98.3, and 87.7%, respectively. The c-indices of the 7-day “the surprise question” and 7-day temporal question were 0.662 (95% CI: 0.539–0.785) and 0.521 (95% CI: 0.464–0.579), respectively. The c-indices of the 42-day “the surprise question” and 42-day temporal question were 0.554 (95% CI: 0.509–0.599) and 0.616 (95% CI: 0.569–0.663), respectively. Significance of results Surprisingly, “the surprise questions” and temporal questions had similar accuracies. The high specificities for the 7-day “the surprise question” and 7- and 21-day temporal question suggest they may be useful to rule in death if positive.

Elucidate recognition of end-of-life care by nursing care staff in elderly care facilities, and factors influencing such recognition. Methods: We conducted an internet questionnaire with 500 nursing care staff working at elderly care facilities across Japan, and an interview with 10 nursing care staff out of 500. Results: In the questionnaire, facility policies (41%) and cooperation with medical staff (38%) were selected as facilities and systems that are important for end-of-life care, and as a concern, sudden change in the condition of the patient, leading to death (53%) was selected. The interview showed that nursing care staff had a certain level of anxiety regardless of their experience with end-of-life care, with participants discussing their thoughts on how systematic learning of, and actual experience in, end-of-life care changed end-of-life care. Conclusion: Our study showed that systematic learning and experience of end-of-life care were important factors in recognition of end-of-life care by nursing care staff when providing such care in elderly care facilities.

Purpose: This study explored risk factors, risk diseases and specific prescriptions related to inappropriate prescribing (IP) as identified by the criteria of the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) among elderly home care patients in Japan. Methods: This cross‐sectional study enrolled all patients aged 65 years or older who received regular home visiting services. Results: This study included 430 patients (276 females). Of the study population, 34.0% had at least one potentially inappropriate medications (PIMs) and 60.0% had at least one incidence of potential prescribing omissions (PPOs). Risk factors or risk diseases for receiving PIMs were hypertension (Regression Coefficient 0.89, P < 0.001, 95%CI 0.53–1.25), constipation (0.95, <0.001, 0.58–1.31), osteoarthritis (1.02, <0.001, 0.56–1.48), recent history of fall (0.90, <0.001, 0.46–1.33) and number of drug (0.11, <0.001, 0.07–0.15), while those for PPOs were osteoporosis (0.66, <0.001, 0.47–0.85), atrial fibrillation (0.23, 0.047, 0.00–0.45), diabetes mellitus (0.78, <0.001, 0.60–0.97), peripheral artery occlusive disease (0.41, 0.002, 0.15–0.68), cerebral infarction/transient ischemic attack (0.76, <0.001, 0.58–0.94), chronic obstructive pulmonary disease (0.61, <0.001, 0.32–0.90), heart failure (0.44, 0.004, 0.14–0.73), bronchial asthma (0.52, <0.046, 0.01–1.04) and coronary artery disease (1.21, <0.001, 1.03–1.40). Conclusion: Risk factors or risk diseases for IP included polypharmacy and several underlying medical conditions. Specific prescriptions associated with PIMs and PPOs were identified.