Mitsunori Miyashita

• RN, PhD.
• Professor at Tohoku University

Objectives: Although unfinished business is associated with psychological states in bereaved families of patients with cancer, no evaluation tools have been developed for such families in Japan. This study aimed to develop and examine the validity and reliability of an evaluation tool for unfinished business among families of terminally ill patient...

Background Palliative care phase is a tool to assess five phases that reflect a patient’s care needs: stable, unstable, deteriorating, terminal, and bereavement. The palliative care phase is routinely used to describe the clinical status of patients and their families. Australia has established nationwide benchmarks for comparing care services. How...

Objectives Communicating prognosis and changes in a patient’s condition is essential in patient-centred care. However, little is known about how families experience medical communication during the dying phase. This study aimed to evaluate family members’ satisfaction with such communication, identify factors associated with dissatisfaction and exp...

Aims: Patients in critical care settings often experience significant suffering, and managing their symptoms can be challenging. This study aimed to clarify the status of routine symptom screening by critical care specialist nurses, the challenges in symptom management, the recognition of the need for specialized palliative care, the rates of consu...

Objective With the aging population, family caregivers, including young adults, play an increasingly important role in supporting patients with cancer. This study compares the caregiving burden and psychological vulnerability faced by individuals caring for parents with terminal cancer during end‐of‐life (EOL) care and bereavement among three age g...

Background We previously developed a 24-item Terminal Delirium-Related Distress Scale (TDDS) to evaluate patient and family distress due to terminal delirium. However, a scale with fewer evaluation items was needed to reduce the burden on terminally ill patients and their families. Thus, the TDDS Shortform (TDDS-SF) was developed, and the validity...

Background There is limited quantitative evidence regarding good death for people with dementia. Aims To clarify which components of good death are important for people with dementia and to identify the component structure of good death through explanatory factor analysis. Design A web‐based questionnaire survey was conducted where bereaved famil...

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 de...

Background In the Fourth Basic Plan to Promote Cancer Control Programs, the number of medical practices using claims data from the National Database (NDB) is measured as a clinical indicator. This study aimed to clarify the characteristics of patients who received care as an indicator of medical practices using more manageable claims data. Methods...

Objective Pain is subjective, and self-reporting pain might be challenging. Studies conducted to detect pain using biological signals and real-time self-reports pain are limited. We evaluated the feasibility of collecting pain data on healthy females’ menstrual pain and conducted preliminary analysis. Results Five healthy adult females participate...

Background In Japan, about 70%–80% of cancer deaths occur in hospitals. The actual number of cancer patients who die in hospitals where palliative care is available is not clear. This study aimed to examine whether hospitals where cancer patients died offered palliative care. Methods Patients aged ≥20 who died of cancer in 2018 were included. We u...

Objectives: Anticipatory grief is associated with post-bereavement grief; however, reports on the influence of pre-loss depression are limited. Therefore, we investigated the association between the anticipatory grief of family members and post-loss and post-depression grief adjusted for pre-loss depression. Methods: This cohort study included the...

Aim Patient‐reported outcome measures (PROMs) are increasingly used in palliative care to evaluate patients' symptoms and conditions. Healthcare providers often collect PROMs through conversations. However, the manual entry of these data into electronic medical records can be burdensome for healthcare providers. Voice recognition technology has bee...

Objective This study aimed to explore the social factors of patients and caregivers, including those related to their wishes for home-based end-of-life care that influence its fulfillment. Methods A secondary analysis was conducted using the dataset (home-based end-of-life care N = 625, hospital end-of-life care N = 7603) Comprehensive patient-bas...

Background: Because of the limitations of pharmacological therapy, nonpharmacological therapies including intervention procedures are also important for quality of cancer pain management. Objective: To clarify the availability of, number performed, barriers to performing, and educational practices of four interventional procedures (celiac plexus ne...

Objectives: To investigate the current state of primary palliative care practice in Japanese critical care settings, identify care perceived as equivalent to primary palliative care, and explore the barriers. Methods: We employed a quantitative descriptive questionnaire survey with a nationwide cross-sectional design involving 740 critical care spe...

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...

Purpose To clarify the current use of unapproved and unproven cancer treatment (UUCT) among the bereaved families of patients with cancer who died in palliative care units, the financial burden and psychological experiences of the families, and the relationship between patients in palliative care who used UUCT and communication with their physician...

Background: Discussing prognosis and end-of-life (EOL) care with patients and physicians is a sensitive and critical aspect of EOL care. However, the association between prognostic awareness and EOL discussions and the quality of death and dying (QOD) remains uncertain. This study aimed to describe prognostic awareness and participation in EOL disc...

Objectives Coping styles can be improved by dyadic palliative care interventions and may alleviate patients’ and family caregivers’ distress. Moreover, family caregivers’ preloss resilience protects against depression after bereavement. This study aimed to determine the types of coping styles can be encouraged to increase resilience. MethodsA self-...

Objectives Achieving a ‘good death’ is one of the important goals of palliative care. Providing goal-concordant care and an environment tailored to the patient’s preferences can contribute to a ‘good death’. However, the concordance rate between the preferred and actual places of death among advanced cancer patients in Japan is less explored. This...

Background Outcome measures during acute cardiovascular disease (CVD) phases, such as quality of death, have not been thoroughly evaluated. This is the first study that compared the family members’ perceptions of quality of death in deceased CVD patients and in deceased cancer patients using a bereaved family survey. Methods Retrospectively sent q...

Background: Patients with coexisting cancer and dementia often have complex health care needs and face challenges in achieving a good death. Objectives: To evaluate good death achievement and end-of-life (EOL) care in patients with coexisting cancer and dementia from the perspective of bereaved families. Design: Cross-sectional nationwide postal su...

Purpose Advanced cancer patients have nutrition impact symptoms (NISs), while many of them have depressive moods. This study aimed to determine the associations of NISs with depression. Methods This study was a secondary analysis. The dietary intake and 19 NISs in patients receiving palliative care were evaluated using 10-point scales, and the pat...

Purpose To clarify the current use of unapproved and unproven cancer treatment (UUCT) among the bereaved families of patients with cancer who died in palliative care units, the financial burden and psychological experiences of the families, and the relationship between patients in palliative care who used UUCT and communication with their physician...

Objective This study explored how the economic and social circumstances of patients' and their caregivers influenced home-based care. Methods A secondary analysis was conducted using the dataset (home-based end-of-life care N = 625, hospital end-of-life care N = 7603) Comprehensive patient-based survey conducted by The Study on Quality Evaluation...

Background: The importance of high-quality care for terminal patients is being increasingly recognized; however, quality of care (QOC) and quality of death and dying (QOD) for noncancer patients remain unclear. Objectives: To clarify QOC and QOD according to places and causes of death. Design, Subjects: A nationwide mortality follow-back survey was...

Background Patient-Reported Outcomes (PROs) are recommended for use in clinical oncology. However, they are not routinely used in professional palliative care practices in Japan. The reasons include both patient and healthcare provider factors and the implementation of PROs. This study aimed to develop and validate clinical implementation methods f...

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...

Objective Cancer patients with children are increasing; however, few studies have quantitatively assessed the parenting concerns of cancer patients with children. The Parenting Concerns Questionnaire was developed in the USA in 2012 and is the only instrument to measure the parenting concerns of cancer patients with children. This study aimed to de...

Background Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. Aim To develop a multidimensional international palliative care goals model in dementia for use in practice. Design...

Background This study aimed to clarify the situation and evaluate the communication on anticancer treatment discontinuation from the viewpoint of a bereaved family, in reference to the concept of nudges. Methods A multi-center questionnaire survey was conducted involving 350 bereaved families of patients with cancer admitted to palliative care uni...

Aim To support informal caregivers, a simple assessment tool capturing the multidimensional nature of caregiving experiences, including negative and positive aspects, is required. We developed a short form of the Japanese version of the Caregiver Reaction Assessment (CRA‐J), a multidimensional assessment scale for caregiver experiences. Methods Th...

A secondary analysis of data from national bereavement surveys conducted in 2014, 2016, and 2018 was conducted with the aim of identifying the contribution of various patient and bereavement backgrounds to the outcomes of the Bereavement Survey. The data were evaluated in terms of structure and process of care (CES), achievement of a desirable deat...

Background: Patients in intensive care units (ICUs) often require quality palliative care for relief from various types of suffering. To achieve quality palliative care, specific goals need to be identified, measured, and reported. The present study aimed to develop quality indicators (QIs) for palliative care in ICUs, based on a systematic review...

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...

Purpose: To examine the feasibility of the Integrated Palliative care Outcome Scale (IPOS), a comprehensive palliative care scale, for non-cancer patients. Methods: Twenty non-cancer patients and 20 healthcare providers who provide care to the participating patients were asked to complete the IPOS questionnaire, and cognitive interviews were conduc...

Background: Death pronouncement is an important moment that can impact a family's bereavement process; however, necessary improvements in physicians' behavior during death pronouncement remain unclear. Objectives: To explore whether the lack of certain behaviors by the physician was associated with a perceived need for improving death pronouncement...

Background Purposeless physiological monitoring at the end-of-life is not recommended. However, studies on how families feel regarding the death of patients with terminal cancer without continuous electrocardiographic monitoring (CEM) are lacking. Objectives To explore the impact on the quality of care and the feelings and psychological distress e...

To describe aggressive treatments at end‐of‐life among inpatients with cancer and non-cancer diseases and to evaluate factors associated with these treatments using the Japanese national database (NDB). We conducted a retrospective cohort study among inpatients aged ≥ 20 years who died between 2012 and 2015 using a sampling dataset of NDB. The outc...

Background: Enhanced discussions regarding end-of-life (EOL) are crucial to provide appropriate care for seriously ill patients. However, the current status of EOL discussions, especially their timing and influencing factors, among patients with cardiovascular diseases (CVD) remains unknown. Methods and Results: We conducted a cross-sectional quest...

This study aimed to explore factors associated with ambulance use and emergency department (ED) visits among people with dementia in the month before death. A web‐based survey of bereaved family caregivers of people with dementia was conducted in March 2020. Multivariate logistic regression analyses were conducted with ambulance use and ED visits i...

Purpose Although opioids have been shown to be effective for cancer pain, opioid-induced adverse events (AEs) are common. To date, little is known about the differences in risks of AEs by opioid type. This study was performed to compare the prevalence of AEs across opioids commonly used for analgesic treatment in Japan. Methods This study was cond...

Objective: The aim of this study is to clarify the preferred place of death and related factors when dementia occurs, targeting the bereaved families of dementia patients and medical professionals. Methods: Cross-sectional internet survey was conducted in October 2019. The subjects were the bereaved family (n = 618), doctors (n = 198), nurses (n =...

Objective: This study examined the relationship between the quality improvement activities in Japanese palliative care units and the bereavement outcomes of patients’ family members. Methods: From a post-bereavement survey (J-HOPE4) conducted in 2018, we sourced the data of 187 facilities. We summarized the quality improvement activities palliative...

Objectives: This study aimed to validate the Japanese versions of the Trust in Oncologist Scale (TiOS-J) and the TiOS-Short Form (TiOS-SF-J). Methods: A cross-sectional web-based survey was conducted among cancer patients in Japan. The forward-backward translation method was used to develop the TiOS-J. The web-based survey was mailed to 633 peop...

Purpose: This study aimed to clarify the situation and evaluate the communication on anticancer treatment discontinuation from the viewpoint of a bereaved family, in reference to the concept of nudges. Methods: A multi-center questionnaire survey was conducted involving 350 bereaved families of patients with cancer admitted to palliative care units...

Purpose: Although opioids have been shown to be effective for cancer pain, opioid-induced adverse events (AEs) are common. To date, there is very little evidence suggesting that any one opioid agonist has a substantially better AE profile than any other. This study was performed to compare the prevalence of AEs across opioids commonly used for anal...

Purpose Hospital-based palliative care teams (HPCTs) are widespread internationally, but multicenter studies about their effectiveness, using patient-reported outcomes (PROs), are limited to Australia and a few other countries. We conducted a multicenter, prospective observational study in Japan to explore the effectiveness of the HPCTs using PROs....

Background: Cancer patients often have impaired renal and hepatic function. Opioids are essential to relieve painful symptoms in cancer patients. However, it is unknown which opioids are first prescribed for cancer patients with renal and hepatic impairment. The objective is to investigate the association between the type of first prescribed opioi...

Background: Swallowing disorders including difficulty swallowing and food bolus obstruction, result in reduced dietary intake-a common occurrence that leads to cachexia in patients with advanced cancer. This study examined the effects of swallowing difficulty and food bolus obstruction on cachexia-related quality of life (QOL). Methods: This stu...

Aim: This study assessed the validity and reliability of the Integrated Palliative Care Outcome Scale for non-cancer patients. Methods: We recruited 223 non-cancer patients receiving palliative care and their healthcare providers (222) across two home care facilities and two hospitals for a cross-sectional study. We assessed the construct validi...

Purpose: Achieving “good death” is one of the important goals of palliative care. Providing goal-concordant care and an environment tailored to the patient's preferences can contribute to “good death.” However, the concordance rate between the preferred and actual places of death among advanced cancer patients in Japan is less explored. This study...

Purpose: Palliative care implementation should take into account the perceptions and acceptability of healthcare providers. This study aimed to identify physicians’ perceptions of palliative care and barriers to palliative care practice in the critical care setting. Methods: A nationwide, self-administered questionnaire was distributed to physician...

Objective: To develop the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) and examine its validity and reliability. Methods: A cross-sectional, web-based survey was conducted among cancer patients in Japan. The PSQ-J was developed following the forward-backward translation method, using a numerical rating scale. Data on patien...

Objective The prevalence of dementia and cancer has increased in recent years. The presence of dementia complicates the care of terminal cancer patients and affects their family caregivers. However, palliative care research seldom focuses on the family caregivers of patients with terminal cancer and dementia. This study aimed to evaluate the degree...

Identifying the cause of death is important for the study of end-of-life patients using claims data in Japan. However, the validity of how cause of death is identified using claims data remains unknown. Therefore, this study aimed to verify the validity of the method used to identify the cause of death based on Japanese claims data. Our study popul...

Background and objective: Interstitial lung disease (ILD) is progressive with high symptom burdens and poor prognosis. Patients with ILD need optimal palliative care to maintain their quality of life, however, few nationwide surveys have addressed palliative care for ILD. Methods: A nationwide, self-administered questionnaire was conducted. Ques...

Background: Discrepancies in symptom assessment between providers and patients are reported in cancer care, and the use of patient-reported outcome measures (PROMs) has been recommended for patients receiving palliative care. However, the status of the routine use of PROMs in palliative care in Japan is presently unclear. Therefore, this study aim...

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 sea...

The aims of this study were (1) to develop and validate the scale to measure evidence-based nursing practice in cancer pain management and (2) to identify associated factors. We developed potential items based on the 2014 version of Japanese Clinical Guidelines for Cancer Pain Management and administered anonymous questionnaire for 189 oncology nur...

PurposeTaste and smell are used to enjoy meals; however, impairments of these sensory perceptions seriously impact health and eating habits. This study is aimed at investigating the impact of taste and smell disturbances on dietary intakes and cachexia-related quality of life (QOL) in patients with advanced cancer.Methods Using a self-report questi...

Background: Patients with advanced cancer have been reported to be more likely to receive goal-concordant care if they have accurate prognostic awareness. However, many patients do not have this awareness. This study aimed to examine the prognostic awareness among Japanese patients with advanced cancer. Methods: This single-center, follow-up coh...

Purpose This study assessed the validity and reliability of the Integrated Palliative Care Outcome Scale (IPOS) for non-cancer patients. Methods We recruited 223 non-cancer patients receiving palliative care and their healthcare providers (222) across two home care facilities and two hospitals for a cross-sectional study. We assessed the construct...

Objective: This study aimed to investigate the feasibility of a patient registry system for assessing PCT (palliative care team) by PRO (Patient-reported outcome) in Japan. Methods: We operated a patient registry system with electronic data collection at eight hospitals in 2021 in Japan. We consecutively included newly referred patients for a month...

Context: Bereaved family members sometimes experience distress due to stressful life events. However, the effects of this distress on depression and grief remain unclear. Objectives: To clarify the degree of distress due to post-bereavement stressful life events, its associated factors, especially social isolation, and its effects on major depre...

Background: Eating-related distress (ERD) is one type of psychosocial distress among advanced cancer patients and family caregivers. Its alleviation is a key issue in palliative care; however, there is no validated tool for measuring ERD. Methods: The purpose of this study was to validate tools for evaluating ERD among patients and family caregi...

Objectives We aimed to estimate the potential population that requires palliative care, clarify the relationship between this population and the rate of ageing in Japan, and compare these trends with those of other countries. Design We used the national death registration data and population projections for Japan to estimate the population in need...

Background: Cancer-related fatigue (CRF) is a highly distressing symptom in patients with cancer. Although various interventions have been reported to reduce fatigue, few are available for use in terminally ill cancer patients, and it is unknown which interventions are effective. They are also often difficult to implement in terminally ill patient...

Background Acute exacerbation (AE) is a major cause of death in patients with idiopathic pulmonary fibrosis (IPF). AE-IPF patients require optimal palliative care; however, the real-world clinical situations are poorly understood. We aimed to survey the palliative care received by AE-IPF patients, especially with respect to opioid use for dyspnea a...

Objectives: To clarify the relationship between Phase of Illness at the time of admission to palliative care units and symptoms of patients with advanced cancer. Methods: This study was a secondary analysis of the East Asian collaborative cross-cultural Study to Elucidate the Dying process. Palliative physicians recorded data, including Phase of...

Objective: End-of-life experiences (ELEs), such as deathbed visions (DBVs), have been reported worldwide. However, ELEs have rarely been discussed in clinical practice, possibly because of the different perceptions of ELEs among clinicians and families. Therefore, this study aimed to investigate the differences in perception regarding ELEs, especi...

Background: People receiving palliative care have complex, wide-ranging, and changing needs, not just physical distress, but also psychosocial, practical, and spiritual. Influences on complexity in palliative care are different among healthcare providers and may depend on diverse aspects of the patient's condition, time, and environment. Therefore...

Objective: The aims of this study were to (i) clarify whether there are differences between bereaved families and medical staffs in their preferences for life-prolonging treatments, and (ii) investigate the factors associated with preferences for life-prolonging treatments. Methods: Cross-sectional internet survey was conducted in October 2019. Par...

Purpose All five senses (i.e., sight, smell, hearing, taste, and touch) are used to enjoy meals; however, impairments in sensory perception, which are common among cancer patients, seriously impact health and cause eating-related distress. Methods Using a self-report questionnaire, we surveyed patients with advanced cancer undergoing treatment at...

Background Cancer pain may be refractory to standard pharmacological treatment. Interventional procedures are important for quality of analgesia. The aim of the present study was to clarify the availability of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathec...

Introduction: Health literacy has been identified an essential factor in leading a healthy lifestyle. Because some cancer prevention and screening methods have been established, we believe that identifying disadvantaged populations with low literacy regarding cancer is crucial. Thus, in this study, we aim to create a self-administered cancer-speci...

Purpose It is important for palliative care providers to identify what factors are associated with a “good death” for patients with advanced cancer. We aimed to identify factors associated with a “good death” evaluated by the Good Death Scale (GDS) score among inpatients with advanced cancer in palliative care units (PCUs) in Japan. Methods The st...

Background Few studies have developed automatic systems for identifying social distress, spiritual pain, and severe physical and phycological symptoms from text data in electronic medical records. Aim To develop models to detect social distress, spiritual pain, and severe physical and psychological symptoms in terminally ill patients with cancer f...

Background: The beliefs and perceptions of parenteral nutrition and hydration (PNH) by advanced cancer patients have not been elucidated. Objectives: To clarify their beliefs and perceptions and to explore the relationships between their beliefs and perceptions and cachexia stages. Design/setting/subjects: A questionnaire survey of advanced cancer...

Background Bereaved family members are known to have a higher risk of suicide, although relevant research is lacking. We aimed to clarify the percentage of bereaved family members of patients with cancer who experience suicidal ideation and the associated factors. Methods We conducted a secondary analysis of two cross-sectional nationwide bereavem...

Background Consumption of opioids, essential drugs for pain relief, has seen rapid growth worldwide. In Japan, where total opioid consumption still remains low among developed countries, little is known about trends in the clinical patterns of opioids in terminally ill cancer patients. Methods Patients who died of cancer from 2010 to 2019 were inc...

Purpose Patients with advanced cancer have been reported to be more likely to receive goal-concordant care if they have accurate prognostic awareness. However, many patients do not have this awareness. This study aimed to examine prognostic awareness in Japanese patients with advanced cancer. Methods This single-center, follow-up cohort study incl...

Purpose It is important for palliative care providers to identify what factors are associated with "good death" for patients with advanced cancer. We aimed to clarify factors associated with "good death" evaluated by the Good Death Scale (GDS) score among inpatients with advanced cancer in palliative care units (PCUs) in Japan. Methods The study i...

Purpose Cancer of unknown primary site (CUP) is an aggressive disease with poor prognosis. As research on the experiences of CUP patients and their families is scarce, this study aimed to compare the family caregiver-perceived burden of CUP with that of common cancers (lung, colon, and stomach cancers). The association between family caregiver-perc...

Objectives: we investigated the prevalence and associated factors of depression and complicated grief (CG) among bereaved family members of malignant pleural mesothelioma (MPM) patients in Japan. Methods: Bereaved family members of MPM patients (n = 72) were surveyed. The Japanese version of the Patient Health Questionnaire-9 (PHQ-9) and the Jap...