Yoshiyuki Kizawa

• Professor
• Professor at University of Tsukuba

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: 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...

Purpose Japan has insufficient palliative care specialists, so there are calls for a palliative care consultation system to aid primary care physicians. Community-based palliative care may require clarification on the division of tasks and responsibilities. Primary care physicians’ needs specific to palliative care are also ambiguous. We therefore...

Objective: To identify effective strategies to provide high-quality palliative care in settings where palliative care specialists are scarce, particularly in Japan. Methods: A scoping review of literature (in English) was conducted using Arksey and O’Malley’s methodological framework. Electronic databases (MEDLINE, CINAHL, and the Cochrane Library)...

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...

Objectives: This study aimed to describe the difficulties faced by physicians in providing palliative care to patients with cancer in facilities without palliative care specialists. Methods: Semi-structured interviews were conducted with 11 physicians involved in cancer treatment who were affiliated with facilities having no palliative care special...

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...

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...

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...

This study sought to explore the unmet palliative care needs of patients diagnosed with Stage B chronic heart failure (CHF) according to the American Heart Association (AHA) and American College of Cardiology (ACC) classifications. We conducted this cross-sectional study between June 1 and August 31, 2020, at Kobe University Hospital. Patients were...

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...

Background Consultation with palliative care specialists can be beneficial in addressing the numerous demands of patients with cancers and their families within communities. In settings lacking palliative care specialists, establishing a new community-based palliative care consultation system necessitates gathering evidence to support its developme...

Background In Confucian-influenced Asian societies, explicit end-of-life conversations are uncommon and family involvement in decision-making is crucial, which complicates the adoption of culturally sensitive advance care planning. Aim To develop a consensus definition of advance care planning and provide recommendations for patient-centered and f...

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 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 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...

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...

Background/Aim: Patients diagnosed with cancer are expected to choose one or more treatment modalities after receiving corresponding explanations of the options. When making these choices, patients consider the effects of treatment and aspects related to their quality of life. These concerns can cause confusion and conflict owing to the complicated...

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...

Introduction/Objectives There is growing consensus on the benefits of initiating palliative care early in the disease trajectory; however, palliative care needs for non-cancer patients remain to be elucidated. We investigated the trajectory of unresolved palliative care needs of non-cancer patients at home and explored associated factors. Methods...

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...

Background: We investigated factors involved in decision-making support provided by physicians, nurses, pharmacists and medical and psychiatric social workers involved in cancer care. Materials & methods: A questionnaire survey on decision-making support was conducted. The level of clinician support was classified as ‘supporting patients’ ‘decision...

Background: Opioid-induced constipation is common and greatly affects the quality of life but is often under-recognised and undertreated. This study aimed to investigate the safety and effectiveness of naldemedine for opioid-induced constipation with cancer pain according to specific subgroups of clinical interest. Methods: In this exploratory post...

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...

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 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....

The aim of the "Japanese Clinical Practice Guidelines for Head and Neck Cancer - 2022 Update" is to review the latest evidence regarding head and neck cancer and to present the current standard approaches for diagnosis and treatment. These evidence-based recommendations were created with the consensus of the Guideline Committee, which is composed o...

Background: Most people in Japan wish to spend their final days at home, but the majority fail to do so; earlier studies indicated a more pronounced worsening of symptoms if treated at home. Objectives: This study compared the prevalence of symptom worsening and explored associated factors between patients with advanced cancer receiving palliative...

Frailty, advanced multimorbidity and uncertainty are important for palliative care in the elderly. To provide quality palliative care, a detailed palliative care assessment needs to be carried out and a proactive approach needs to be taken based on the assumption that there is uncertainty.

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 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...

Background: Nurses providing end-of-life care experience not only burnout and compassion fatigue, but also positive effects such as compassion satisfaction. Nurses' compassion satisfaction was shown to be related to job satisfaction, work engagement, and nurse caring. Studies in emergency departments, intensive care units, oncology wards, and gene...

Background: Specialist palliative care for non-cancer patients is important; however, access to inpatient hospices/palliative care units (PCUs) for non-cancer patients in Japan may be insufficient. We aimed to explore the current situation, the support needs to accept admission of non-cancer patients, and the willingness to accept admission of non...

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: Prognostic information, which consists of life expectancy, functional prognosis, and uncertainty, of cancer patients is essential. However, the evidence regarding the prognostic preferences of cancer patients is limited. To clarify the prognostic preferences of cancer patients and whether cancer patients want to be informed about their...

Aspiration pneumonia (AP) is the leading cause of death among the elderly in Japan. The factors associated with the survival of elderly patients with AP are investigated in this retrospective observational study. Patients with AP over the age of 60 who were assessed for swallowing function in our hospital between April 2015 and March 2016 were elig...

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...

Context A conceptual framework for advance care planning is lacking in societies like Japan's valuing family-centered decision-making. Objectives A consensus definition of advance care planning with action guideline adapted to Japanese society. Methods We conducted a multidisciplinary modified Delphi study 2020–2022. Thirty physicians, 10 healthc...

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...

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...

Purpose Some patients experience intense symptoms refractory to intensive palliative care, and palliative sedation is sometimes used. Palliative sedation may be classified into proportional and continuous deep sedation (CDS). The primary aim of this study was to compare family experience between families of patients who received proportional or CDS...

Purpose No studies have investigated the association between malignant brain tumor and the quality of dying, which is an important outcome in end-of-life care. This study aimed to clarify whether the quality of dying and related factors in patients with malignant brain tumor differ from those in patients with other malignant diseases. Methods This...

Background: This study aimed to explore (i) the consistency between physician-rated and bereaved family-perceived intensity of death rattle, (ii) the relationship between intensity of death rattle and the bereaved family's distress and (iii) the bereaved family's experience and feelings related to suctioning for death rattle. Methods: We used ma...

Background: The type and frequency of palliative care needs of chronic heart failure (CHF) patients have not been determined in Japan. Objectives: The aim of this study was to comprehensively assess the prevalence and characteristics of palliative care needs of CHF outpatients. Methods: Patients were recruited for this cross-sectional study from Ju...

Background: Bathing in a tub is integral to Japanese culture. It improves palliative care patients' symptoms and may improve quality of life. Objectives: This study aimed to determine the prevalence and impressions of bathing for terminally ill cancer patients and its relations to the evaluations of perceived end-of-life care and achievement of a g...

Background Inpatient palliative care units (PCUs) have two roles: place of death and symptom control. In case of symptom control, most patients whose distressing symptoms could be relieved would be temporarily discharged back home. However, the experience of the patient and their family during temporary discharge is unclear. Methods This study is...

Objective: Research on the association between circumstances of death in advanced cancer patients and depression in their bereaved caregivers is limited. Methods: A longitudinal study was performed on patients admitted to 21 inpatient hospices/palliative care units (PCUs) in Japan. Patient symptoms were assessed at admission and in the last 3 da...

Background It is currently unknown how widespread is the practice of palliative care in intensive care units (ICUs) in Japan. This study aimed to determine evaluate the delivery and self-reported practice of palliative care in ICUs in Japan. Methods A self-administered questionnaire was sent to the physician directors of all 873 ICUs in Japan in A...

Purpose: No studies have investigated the association between malignant brain tumor and the quality of dying, which is an important outcome in end-of-life care. This study aimed to clarify whether the quality of dying and related factors in patients with malignant brain tumor differ from those in patients with other malignant diseases. Methods: Thi...

PurposeAlthough home care improves patients’ quality of life (QOL), several studies have suggested that home care lowers the QOL of family caregivers and decreases their mortality. To alleviate the deleterious impact of home care on caregivers, the major burdens on caregivers and the clinical characteristics of the caregivers vulnerable to the majo...

Aim: To explore the unclear association between temporary discharge home from the palliative care unit and achievement of good death, in the background of increases in discharge from the palliative care unit. Association between experiences and circumstances of patient and family and duration of temporary discharge was also examined. Methods: Th...

Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients’ and families’ experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questio...

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-perceived burden of CUP with that of common cancers (lung, colon, and stomach cancer). Additional aims were to explore the association between...

PurposeThe benefits of parenteral nutrition and hydration (PNH) in patients with advanced cancer remain unknown. Therefore, we conducted a prospective multicenter cohort study to assess the effects of PNH on survival in patients with malignant bowel obstruction (MBO).Methods The present study was a secondary analysis. Data on primary nutritional ad...

Background: Advance care planning (ACP) discussions are often procrastinated due to both physician and patient factors. However, ACP should be started earlier, to provide more time for reviewing one's values and discussing them with loved ones and medical professionals. This study examined the effectiveness of ACP discussions with health care prov...

Background & Aims The prevalence of artificially administered nutrition and hydration (AANH) in different age groups among patients with advanced cancer remains unknown. The present study investigated the current utilization of AANH according to age groups in palliative care units. Methods This was a secondary analysis of a prospective cohort stud...

Introduction Health and social care services worldwide need to support ageing populations to live well with advanced progressive conditions while adapting to functional decline and finitude. We aimed to identify and map common elements of effective geriatric and palliative care services and consider their scalability and generalisability to high, m...

Background: Patients with life-limiting illnesses frequently experience urinary difficulties, and urinary catheterization is one of the interventions for managing them. However, evidence supporting the effects of urinary catheters on the quality of death (QoD) is lacking in this population. Objectives: To investigate whether urinary catheterization...

Background: Palliative care is an essential component of comprehensive care for patients with critical illnesses. In Japan, little is known about palliative care in intensive care units (ICUs), and palliative care approaches are not widespread. This study aimed to better understand the attitudes of physicians toward palliative care and the utilizat...

Opioid-induced constipation (OIC) can limit the clinical benefit of opioid treatment. This post-hoc analysis evaluated the association between the Rome IV diagnostic criteria and other measures for OIC, including the Bowel Function Index (BFI), correlation between demographics and OIC onset, impact of OIC on pain treatment, and impact of patient–he...

Purpose The aims of this study were to examine the prevalence of myoclonus, sweating, pruritus, hiccup, and vesical and rectal tenesmus, and to explore associated factors in patients with advanced cancer. Methods This multicenter prospective cohort study was conducted in 23 inpatient hospices/palliative care units in Japan from January to December...

The study aim was to clarify the essential competencies for psychologists in palliative care teams. A nationwide, multicentre cross-sectional survey was conducted. A 32-item questionnaire assessing endorsement of potential competencies was completed by 70 patients and/or families, 101 consulting personnel, 747 members of palliative care teams and 2...

Objectives To elucidate changes in depressive symptoms after bereavement and the impact of pre-loss resilience on such changes and on the extent of complicated grief and posttraumatic growth. Methods Prospective cohort surveys were provided to family caregivers of patients with cancer in four palliative care units (PCUs) before and after bereaveme...

Objectives Family conflict during end-of-life care is an important issue for advanced cancer patients and their families, although studies are lacking. We investigated the association between family relationships and family conflict in advanced cancer patients. Methods This study was a secondary analysis of a nationwide multicenter questionnaire s...

Context: Some patients require continuous deep sedation (CDS) for refractory symptoms despite intensive palliative care. The principle of proportionality is proposed on the basis of clinical decisions, but no validated tools to assist such decision making are available. Aim: To develop a scoring system to determine whether CDS is proportionally app...

Background Predictive factors for the development of dyspnea have not been reported among terminally ill cancer patients. Objective This current study aimed to identify the predictive factors attributed to the development of dyspnea within 7 days after admission among patients with cancer. Methods This was a secondary analysis of a multicenter pr...

Background: Advance care planning (ACP) is an important factor that affects the quality of end-oflife. However, health care providers are not able to sufficiently support patients' ACP due to their lack of knowledge and psychological burden. This study investigated how the knowledge, attitudes, and practices of health care providers who completed...

Background: Known barriers to admission into inpatient hospice/palliative care units (PCUs) include poor accessibility and stringent conditions for admission. However, the exact criteria are unclear. The aim of this study was to clarify the actual conditions, possibilities and priorities for admission to PCU in Japan. Methods: We conducted a nat...

In end-of-life care, rehabilitation for terminally ill cancer patients is inconsistently provided and rarely discussed. We sought to clarify the prevalence of unmet rehabilitation need for patients admitted to inpatient hospice/palliative care units as perceived by bereaved family members. We conducted a nationwide questionnaire survey of 1001 fami...

Background: Adult patients with hematologic malignancies are less likely to receive palliative care and more likely to accept intensive anti-cancer treatments until end-of-life than those with solid tumors, but limited data are available regarding the quality of end-of-life care (EOLC) for children with hematologic malignancies. To improve the qua...

Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients’ and families’ experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questio...

Context Family functioning is a modifiable factor associated with major depressive disorder (MDD) and complicated grief (CG) among the bereaved families of patients with advanced cancer; however, the evidence regarding this association is limited. Objectives We aimed to explore the association of family functioning with possible MDD and CG among t...

This study examined differences in sociodemographic characteristics and the achievement of a good death between cancer patients who live alone and those who do not live alone prior to death in different settings. Secondary analysis of data collected across two cross-sectional self-reported questionnaire surveys was undertaken. The participants were...

PurposeAlthough home care improves patients' quality of life (QOL), several studies have suggested that home care lowers the QOL and mortality of family caregivers. To alleviate the deleterious impact of home care on caregivers, the major burdens on caregivers and the clinical characteristics of the caregivers vulnerable to the major burden needs t...

Background Hospice and palliative care services provision for COVID-19 patients is crucial to improve their life quality. There is limited evidence on COVID-19 preparedness of such services in the Asia-Pacific region. Aim To evaluate the preparedness and capacity of hospice and palliative care services in the Asia-Pacific region to respond to the...

Context Terminal dyspnea in dying cancer patients is frequent and distressing, and the impact extends to their families. Families are often involved in providing care for terminal dyspnea. Objectives This study aimed to describe various care strategies for terminal dyspnea in cancer patients hospitalized in palliative care units (PCUs), evaluate f...