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Background: The Care Evaluation Scale (CES1.0) was designed to allow bereaved family members to evaluate the structure and process of care, but has been associated with a high frequency of misresponses. The objective of this study was to develop a modified version of CES1.0 (CES2.0) that would eliminate misresponses while maintaining good reliability and validity. Methods: We conducted a cross-sectional questionnaire survey by mail in October 2013. The participants were bereaved family members of patients who died from cancer in seven institutions in Japan. All family members were asked to complete CES2.0, the short form CES1.0, items on overall care satisfaction, the Family Satisfaction with Advanced Cancer Care (FAMCARE) Scale, the Patient Health Questionnaire-9 (PHQ-9) and the Brief Grief Questionnaire (BGQ). To examine test-retest reliability, all participants were asked to complete a second CES2.0. Results: Of 596 questionnaires sent, 461 (77%) were returned and 393 (66%) were analyzed. In the short form CES1.0, 17.1% of the responses were identified as misresponses. No misresponses were found in CES2.0. We identified 10 CES2.0 subscales similar to those in CES1.0 using exploratory factor analysis. Cronbach's alpha was 0.96, and the intraclass correlation coefficient was 0.83. Correlations were found between CES2.0 and overall satisfaction (r = 0.83) and FAMCARE (r = 0.58). In addition, total CES2.0 scores were negatively correlated with the PHQ-9 (r = -0.22) and BGQ (r = -0.10). Conclusion: These results suggest that CES2.0 eliminated misresponses associated with CES1.0 while maintaining good reliability and validity and greatly improving test-retest reliability. [ABSTRACT FROM AUTHOR]

Background: Comprehensive information on end-of-life care in specialized palliative care settings is needed to assess the quality of care. Objective: This study aimed to investigate medical treatments in the last two weeks of life in a national sample of palliative care units in Japan. Design: Retrospective cohort study. Setting/Subjects: Medical charts of 2802 consecutive cancer patients who died in 37 palliative care units were reviewed. Measurements: Drug usage and treatments during the last two weeks of life were collected. A mixed-effect model was used to estimate the variations in care between institutions. Results: Opioid administration increased from 68% (two weeks before death) to 80% (last 48 hours); during the same period, nonsteroidal anti-inflammatory drugs and acetaminophen administration decreased from 59% to 45%, and corticosteroid administration decreased from 62% to 51%. As death neared, parenteral opioid administration increased (41%-74%). Morphine use increased (45%-70%), fentanyl use remained about the same (47%-40%), and oxycodone use decreased (18%-5%). Two thirds of patients received artificial hydration; doses >1000 mL/day (15%) and intravenous hyperalimentation (7%) were relatively rare during the last 48 hours. Variations in end-of-life medical treatments increased between palliative care units as death neared, especially anticholinergic, artificial hydration, oxygen inhalation, and palliative sedation use. Conclusions: These findings regarding the general course of palliative treatments for dying cancer patients are useful for clinical audits in general wards, by comparing end-of-life care. Variations in some end-of-life medical treatments between institutions increased as death neared, even in palliative care settings. [ABSTRACT FROM AUTHOR]

Context Recently, greater emphasis has been placed on patient-reported outcomes. However, there are only a few measures to evaluate the quality of care from the patient's perspective. Objectives To report the development of a scale to measure the quality of the structure and process in palliative care from the patient's perspective and examine the reliability and validity of the scale. Methods A cross-sectional anonymous questionnaire was administered to cancer patients who were being treated on an oncology inpatient ward, who visited an oncology outpatient clinic at Saitama Medical University International Medical Center, or who were in an inpatient palliative unit in Japan between August 2007 and March 2008. Results A total of 405 cancer patients participated in the study. Factor analysis revealed that the Care Evaluation Scale-Patient version (CES-P) consisted of 23 items with eight subscales: physical care by physicians, physical care by nurses, psychoexistential care, help with decision making for patients, environment, cost, availability, and coordination/consistency. The total CES-P score was correlated with satisfaction (r = 0.63) but not with quality of life (r = 0.18). The Cronbach α coefficient of the total score was 0.97, and the intraclass correlation coefficient of the total score was 0.67. The CES-P total score was not significantly correlated with the self-reported Eastern Cooperative Oncology Group performance status (ρ = -0.05). Conclusion The CES-P has sufficient validity and reliability. In addition, this scale is independent of the general physical condition of the patient. [ABSTRACT FROM AUTHOR]

Context Bereaved family members witnessing a patient's death rattle often experience distress. However, the benefits of specific care measures aimed at decreasing death rattle-associated family distress have not yet been evaluated. Objectives To clarify death rattle-related emotional distress levels among family members and their perceptions of the need for death rattle care improvement and explore the factors influencing both these issues. Methods A cross-sectional questionnaire survey of bereaved family members of cancer patients was conducted in 95 palliative care units in June 2007. Results Six hundred sixty-three questionnaires were mailed out, and 390 (61%) responses were analyzed. Among these, 181 (46%) respondents experienced death rattle. Of these, 66% reported high distress levels and 53% perceived a strong need for improved death rattle care. Factors influencing high distress levels were the gender (female) of family members, unawareness about death rattle being a natural phenomenon, and their fear and distressing interpretations of death rattle. Factors influencing perceptions of a strong need for improved care were the gender (male) of family members, severity of death rattle, death rattle-associated discomfort to patients, family members' experiences of inadequate nursing care (e.g., repositioning) and insufficient consultation about suctioning, and their perception of uncomfortable smells. Conclusion To decrease family-perceived distress, medical staff should alleviate patient symptoms and suffering with a comprehensive care strategy, try to decrease uncomfortable smells, and communicate with family members to address distressing interpretations and fears. [ABSTRACT FROM AUTHOR]

Abstract Goal  Although the importance of the palliative care team (PCT) to university hospitals is widely accepted, the issues of palliative care at the national level have not been clarified. We conducted a nationwide survey of the current status of PCTs in all (123) Japanese university hospitals. Materials and methods  In 2003, 2004 and 2005, the authors conducted a self-reporting cross-sectional survey. Questionnaires were mailed to nursing directors and selected PCT members of all Japanese university hospitals. Results  Of 123 hospitals in 2005, 99 (80%) returned the questionnaire; 33% used PCTs, and 11% used certified PCTs. Our findings include: annual number of patients treated by PCTs (83/70 � 64, mean/median � SD), daily number of patients treated by PCTs (12/11 � 14), and days of PCT care per patient (30/30 � 22). Certified PCTs treated more patients per year (p = 0.004) and more patients per day (p  Conclusions  The entire system of palliative care in Japanese university hospitals is currently insufficient. The lack of physicians and nurses who specialize in palliative care is a significant barrier, and therefore, the initiation of a formal training system for these health care professionals is a high priority issue. [ABSTRACT FROM AUTHOR]

Aim: To investigate the factors affecting the research productivity of young nursing faculty in Japan. Methods: An online survey targeting young nursing scholars (aged ≤39 years) who were members of the Japan Academy of Nursing Science was conducted from October to November 2012. Of 1634 potential respondents, 648 completed the survey (39.7%), and 400 full-time faculty of a baccalaureate degree program were selected for the analysis. The numbers of English-language and Japanese publications in the past 3 years were regressed onto personal characteristics, such as academic degree and type of university. Results: The mean numbers of publications in English and Japanese in the past 3 years were 0.41 and 1.63, respectively. Holding a doctoral degree was significantly related to a higher number of publications in English and Japanese (eβ = 5.78 and eβ = 1.89, respectively). Working at a national university (eβ = 2.15), having a research assistant (eβ = 2.05), and the ability to read research articles in English (eβ = 2.27) were significantly related to more English-language publications. Having the confidence to conduct quantitative research (eβ = 1.67) was related to a larger number of Japanese publications. The lack of mentoring (eβ = 0.97) and university workload (eβ = 0.96) were associated with a lesser number of Japanese publications. Conclusion: The research productivity of young nursing faculty appeared to be quite low. Strategies to enhance research productivity in young nursing faculty, such as encouraging the achievement of a doctoral degree or enrichment of research resources, should be undertaken. [ABSTRACT FROM AUTHOR]