title: [Deliria as an obstacle to continual home care from the perspective of a psycho-oncologist].
abstract: To ensure that cancer patients receive palliative care anytime and anywhere, and are not made to feel invalid after being diagnosed with cancer, the patients and their family members, who may become bereaved in the future, are required to deal with the disease, especially for its early detection. Moreover, the Cancer Control Act and the Basic Plan to Promote Cancer Control passed in 2007 that aimed at home care for as long as possible, has been in force since 5 years now, and discussions are being made to reconsider the basic plan in order to prepare a new 5-year plan. Further, in Japan, 1 million persons die annually and one-third of this population dies of cancer; in the future, this proportion is estimated to increase to half(1 out of 2 persons). Concerning the location for patient care, although many patients want to be at home for care at the terminal stage of cancer, currently, only 10% of the patients are able to stay at home for palliative care. At our hospital, which is an acute-stage health care general hospital with 301 beds, providing average of 10 days of hospitalization, we have also been making efforts in this regard. We have already reported our efforts at the 20th, 21st, and 22nd meetings of Japan Society for Home Therapy Research. To conduct the shift to home care smoothly and to alleviate physical and mental symptoms, the importance of cooperation among multiple specialists has been gaining increasing recognition. At our hospital, the cancer counseling support center and cancer palliative care teams include physicians, nurses(including nurses qualified for cancer-related care), and social workers. As they often partake in decision making with the patients, they aim for home care for the patients who will experience less pain at home during the terminal stage of cancer. At that time, various setbacks may be encountered, and countermeasures against mental symptoms are especially important. Delirium, which is a mental symptom appearing at various instances, generally reduces the quality of life and debilitates the patients' families physically and mentally, leading to poor prognosis or prevention of treatment. Particularly, at the terminal stage of cancer, many aspects such as treatment direction, place of care, etc., must be decided sequentially. Occurrence of delirium often leads to prevention of treatment. Thus, the evaluation, care, and treatment of delirium(including its prevention by environmental adjustment if possible)are important. For this purpose, cooperation among related personnel and training programs are necessary. The cancer counseling center was established in our hospital 3 years ago, and more than 30 cases have been dealt with at this center. Some of these cases may help elucidate future countermeasures against delirium; basic measures would be necessary. Herein, I report the cases referred to above.
authors.affiliation: Dept. of Psychiatry, Head of the Cancer Consultation Support Center, Palliative Care Team, Sapporo Medical Center NTT EC.
authors.forename: Hideo
authors.initials: H
authors.lastname: Takayanagi
mesh_terms: D003693:Delirium; D017809:Fatal Outcome; D006699:Home Care Services; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D010166:Palliative Care