担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of the American Medical Directors Association  

Objectives: To elucidate factors related to the transitions of quality of life (QoL) and well-being in older adults living in residential facilities. Design: We undertook a systematic review and narrative synthesis. Setting and Participants: The participants were individuals aged ≥60 years living in various types of residential facilities. Methods: We conducted a search in PubMed and Embase (Ovid) using free-text words and Medical Subject Heading terms on December 1, 2024. We included longitudinal studies published after 2000 that quantitatively assessed QoL and/or well-being at ≥2 time points. Studies published before 2000, non–English-language papers, and interventional or qualitative studies were excluded. The title, abstract, and full-text assessments were performed by multiple independent reviewers based on eligibility criteria. The Study Quality Assessment Tool for observational cohort and cross-sectional studies was used to assess methodologic quality. Results: Of the 7705 papers initially identified, 18 studies involving 122,057 participants were included. These studies, predominantly multicenter studies and studies conducted in the United States, revealed that QoL and well-being tended to decline gradually after admission. Key factors associated with maintaining and enhancing QoL and well-being included facility-level factors (eg, age-friendly architectural environments, social support and activities) and individual aspects (eg, cognitive function, activities of daily living, urinary continence). The variation in outcome measures precluded a meta-analysis. Conclusions and Implications: We identified both facility- and individual-level factors associated with changes related to QoL and well-being in older adults living in residential facilities. The importance of modifiable facility-level factors should be reconsidered in ensuring quality care for older residents.

DOI： 10.1016/j.jamda.2025.105721

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Pain and Symptom Management  

Context: Early palliative care is recommended within eight-week of diagnosing advanced cancer. Although guidelines suggest routine screening to identify cancer patients who could benefit from palliative care, implementing screening can be challenging due to understaffing and time constraints. Objectives: To develop and evaluate machine learning models for predicting specialist palliative care needs in advanced cancer patients undergoing chemotherapy, and to investigate if predictive models could substitute screening tools. Methods: We conducted a retrospective cohort study using supervised machine learning. The study included patients aged 18 or older, diagnosed with metastatic or stage IV cancer, who underwent chemotherapy and distress screening at a designated cancer hospital in Japan from April 1, 2018, to March 31, 2023. Specialist palliative care needs were assessed based on distress screening scores and expert evaluations. Data sources were hospital's cancer registry, health claims database, and nursing admission records. The predictive model was developed using XGBoost, a machine learning algorithm. Results: Out of the 1878 included patients, 561 were analyzed. Among them, 114 (20.3%) exhibited needs for specialist palliative care. After under-sampling to address data imbalance, the models achieved an Area Under the Curve (AUC) of 0.89 with 95.8% sensitivity and a specificity of 71.9%. After feature selection, the model retained five variables, including the patient-reported pain score, and showcased an 0.82 AUC. Conclusion: Our models could forecast specialist palliative care needs for advanced cancer patients on chemotherapy. Using five variables as predictors could replace screening tools and has the potential to contribute to earlier palliative care.

DOI： 10.1016/j.jpainsymman.2024.01.009

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Palliative Care  

Background: Older people with noncancer conditions are less likely to be referred to palliative care services due to the inherent uncertain disease trajectory and a lack of standardised referral criteria. For older adults with noncancer conditions where prognostic estimation is unpredictable, needs-based criteria are likely more suitable. Eligibility criteria for participation in clinical trials on palliative care could inform a needs-based criteria. This review aimed to identify and synthesise eligibility criteria for trials in palliative care to construct a needs-based set of triggers for timely referral to palliative care for older adults severely affected by noncancer conditions. Methods: A systematic narrative review of published trials of palliative care service level interventions for older adults with noncancer conditions. Electronic databases Medline, Embase, CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov. were searched from inception to June 2022. We included all types of randomised controlled trials. We selected trials that reported eligibility criteria for palliative care involvement for older adults with noncancer conditions, where > 50% of the population was aged ≥ 65 years. The methodological quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Descriptive analysis and narrative synthesis provided descriptions of the patterns and appraised the applicability of included trial eligibility criteria to identify patients likely to benefit from receiving palliative care. Results: 27 randomised controlled trials met eligibility out of 9,584 papers. We identified six major domains of trial eligibility criteria in three categories, needs-based, time-based and medical history-based criteria. Needs-based criteria were composed of symptoms, functional status, and quality of life criteria. The major trial eligibility criteria were diagnostic criteria (n = 26, 96%), followed by medical history-based criteria (n = 15, 56%), and physical and psychological symptom criteria (n = 14, 52%). Conclusion: For older adults severely affected by noncancer conditions, decisions about providing palliative care should be based on the present needs related to symptoms, functional status, and quality of life. Further research is needed to examine how the needs-based triggers can be operationalized as referral criteria in clinical settings and develop international consensus on referral criteria for older adults with noncancer conditions.

DOI： 10.1186/s12904-023-01131-6

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その他リンク： https://link.springer.com/article/10.1186/s12904-023-01131-6/fulltext.html

担当区分：筆頭著者  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本緩和医療学会  

<p>近親者との死別は，遺族にとって重大なストレス体験の一つである．本研究の目的は，親を亡くした遺族において，血縁関係が悲嘆および抑うつに与える影響を明らかにすることである．2017年および2018年に死亡した患者の遺族を対象に質問紙調査を実施し，悲嘆はProlonged Grief Disorder尺度，抑うつはPatient Health Questionnaireにより評価した．性別を補正した結果，悲嘆の有病率は実子で17.7%，実子の配偶者で21.6%，抑うつはそれぞれ39.1%，41.7%で，血縁にかかわらず高い有病率を示した．付き添い頻度等を調整後も，実子であることは悲嘆と関連していた（aOR=1.75, 95% CI: 1.59–1.94）．悲嘆には血縁関係が有意に関連していたが，抑うつには関連が認められなかった．以上より，医療者は血縁の有無だけでなく，すべての遺族に対し，適切な心理的支援を行う視点が求められる．</p>

DOI： 10.2512/jspm.21.13

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Pain and Symptom Management  

Context: Chronic limb-threatening ischemia is associated with a high risk of limb amputation and infection and includes lower limb ischemia, rest pain and gangrene, and impaired physical function. Palliative care for patients with chronic limb-threatening ischemia and their caregivers is important. However, reports on the need for palliative care are in consistent. Objectives: To conduct a scoping review to identify the palliative care needs of patients with chronic limb-threatening ischemia and their caregivers. Methods: We adopted the methodological framework for scoping reviews outlined by Arksey and O’Malley. The protocol was registered with the Open Science Framework (https://osf.io/xc2vq/). PubMed, Ovid Embase, Web of Science, EBSCO CINAHL, Cochrane Library, PsycINFO, and Google scholar were used. Eligibility criteria were studies that described palliative care needs of patients with chronic limb-threatening ischemia and their caregivers, with no limitations on the publication year. Results: Of the 2663 articles, 14 met the eligibility criteria. The major palliative care needs were in relation to structure and process, including early intervention in palliative care and in multidisciplinary teams. Additionally, it was found that healthcare providers did not assess care needs using a comprehensive scale. Two studies used pain scales, such as the Numerical Rating Scale, and one study used a quality of life scale. Conclusion: We recommend that hospitals improve palliative care delivery systems for patients with chronic limb-threatening ischemia and their caregivers and assess their needs using comprehensive patient-reported outcome scales. Further research using existing patient-reported outcome measures that comprehensively assess palliative care needs is needed.

DOI： 10.1016/j.jpainsymman.2025.08.018

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出版者・発行元：Progress in Palliative Care  

Designating a surrogate decision-maker and discussing end-of-life preferences are essential steps to prepare for a potential future loss of decision-making capacity. Yet, little is known about the factors associated with better surrogate understanding of a person’s end-of-life preferences. We aimed to examine which sociodemographic factors, values related to end-of-life care, and decision-making-related factors were associated with perceived surrogate understanding of end-of-life preferences among adults who had designated a surrogate. This cross-sectional study entailed a secondary analysis of data from the Public Awareness of Hospice and Palliative Care Study 2018, a nationwide, web-based survey conducted in Japan. The survey included 1000 adults aged 20–79 who were registered with a market research company. Participants were asked to evaluate the extent to which their designated surrogate understood their end-of-life care preferences. The participants had a mean age of 50.3 years (SD = 15.7), and 51% were female. Among the 873 participants who had designated a surrogate, 57.4% had never discussed their end-of-life preferences with that person. Only 19.9% (n = 174) believed that their surrogate understood their preferences sufficiently. Perceived surrogate understanding was associated with several factors, including age, living status, preferences regarding diagnostic disclosure to family, preferences for end-of-life treatment goals, and the extent of prior end-of-life discussion. The results emphasize the value of end-of-life discussions and the influence of individual characteristics on perceived surrogate understanding.

DOI： 10.1080/09699260.2025.2538914

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記述言語：英語   出版者・発行元：Journal of Palliative Medicine  

Background: Parents who have lost their children to death often experience high levels of grief and depression. However, studies on the grief and depression experienced by parents who have lost an adult child to cancer are scarce. Objectives: To clarify the risk and characteristics of grief and depression in parents who have lost an adult child to cancer. Design: A nationwide mortality follow-back survey was conducted in Japan with participants identified using death certificate data for cancer. Between February 2019 and February 2020, a questionnaire was distributed to 110,990 bereaved family members; 60,797(63.1%) responses were received, and 50,639 were analyzed. Setting/Subjects: The participants included Japanese bereaved families who lost a family member between 2017 and 2018, that is, 13-25 months before initiating this study. At the time of their child’s death, the parents were the primary caregivers. Measurements: Data on key factors such as patient and bereaved family background, family caregiving burden, and bereaved family grief and depression were collected. Results: Bereaved parents who had lost their adult children had a higher likelihood of experiencing grief and depression than those who had lost other family members (adjusted odds ratio: 2.0, 95% confidence interval: 1.71, 2.34). Furthermore, factors such as motherhood and death at home increased the likelihood of grief and depression among bereaved parents. Conclusions: The results suggest that early support is needed for mothers experiencing strong grief and depression, as well as for parents whose adult children die at home.

DOI： 10.1177/10966218251368494

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jpainsymman.2025.08.018

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s41999-025-01299-5

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DOI： 10.1177/10966218251368494

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Oncology Nursing  

Purpose: Artificial intelligence (AI) systems in palliative care have garnered attention and popularity in recent years. Understanding patient and family needs is crucial for developing and implementing AI systems in palliative care. Few studies in palliative care have focused on the demands of terminal patients with cancer and their families toward AI. This study aimed to explore the application of advanced AI in palliative care, focusing on high priority areas, while also analyzing bereaved relatives' perspectives on AI's role in supporting patients with cancer during end-of-life care. Methods: We conducted a web-based questionnaire survey among bereaved family members of deceased patients with cancer. We explored the needs and opinions of the bereaved families regarding using AI for end-of-life care. Results: We analyzed responses from 610 bereaved families. More than 80 % of mourning families wanted AI solutions that could offer the best approach to treat symptoms to health care providers, patients, or informal caregivers, with 79.7 % wishing for AI recommendations for discussions with health care providers. Furthermore, 74.4 % supported AI use in the medical field, while 79.7 % were concerned about accountability and 61.6 % about data leakage. Conclusion: The survey found that development of AI solutions focusing on symptom management and facilitating discussion is the highest priority. Furthermore, this study suggested developing principles and guidance to ensure ethical AI usage is essential.

DOI： 10.1016/j.ejon.2025.102875

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記述言語：英語   出版者・発行元：Journal of Pain and Symptom Management  

The authors regret that the affiliation of M.H., S.Y., M.H., and A.K. was listed as the Department of Clinical Oncology and Chemotherapy at Nagoya University Hospital in Nagoya, Japan. This should have been listed as the Department of Nursing at Nagoya University Hospital in Nagoya, Japan. The authors would like to apologize for any inconvenience caused.

DOI： 10.1016/j.jpainsymman.2024.05.019

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記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

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記述言語：英語   出版者・発行元：Annals of Palliative Medicine  

Background: Establishing appropriate quality assessment indicators for palliative care in intensive care units (ICUs) is vital. This systematic review summarizes the existing quality indicators (QIs) for palliative care in ICUs. It assesses the methodological quality of QI development to pave the way for more valid QIs. Methods: A literature search was conducted using MEDLINE, PsycINFO, CINAHL, Cochrane databases, and the Ichushi-web database for Japanese literature for all studies published until November 2021. The included QIs were drawn from the National Consensus Project for Quality Palliative Care (NCP) and the Donabedian model of quality. Methodological quality was assessed based on the appraisal of indicators through the research and evaluation tool. Results: Five studies were included, from which 109 indicators were extracted: 78% were process indicators, 5% were outcome indicators, and 17% were structure indicators. The most common indicators addressed the palliative care domain of “ethical and legal aspects of care” (n=38, 30%). Another distinctive feature of some indicators was a focus on supporting ICU staff. Regarding methodological quality, the “scientific evidence” varied (11–89%). Most of the data on QI measures and data sources were obtained from a review of electronic medical records (EMRs). Administrative data also provided a few measurable indicators. Conclusions: Out of all the QIs covered in this review, most were process indicators, and only a few were outcome indicators. Ethical and legal aspects of care and support for the ICU staff emerged as unique to palliative care. Although the existing QIs can be used for palliative care in ICUs, more specific indicators are urgently needed. Continuous quality assessment and improvement, as well as the addition of more palliative care practices in ICUs, would provide further evidence and help develop valid QIs.

DOI： 10.21037/apm-22-1005

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