title: Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.
abstract: OBJECTIVE
  The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan.
  
  
  METHODS
  A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care.
  
  
  RESULTS
  The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%).
  
  
  CONCLUSIONS
  Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.
authors.affiliation: Department of System Management in Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan. hfukahori.kanr@tmd.ac.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Fukahori
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Nobuya
authors.initials: N
authors.lastname: Akizuki
authors.forename: Miki
authors.initials: M
authors.lastname: Akiyama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shirahige
authors.forename: Kenji
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006270:Health Facility Administrators / Q000523:psychology*; D006738:Hospices / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008134:Long-Term Care / Q000458:organization & administration*; D009369:Neoplasms / Q000628:therapy*; D009735:Nursing Homes / Q000458:organization & administration; D010166:Palliative Care / Q000458:organization & administration; D012112:Residential Facilities / Q000458:organization & administration; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration*