• Akihiko Ozaki, Masaharu Tsubokura, Claire Leppold, Toyoaki Sawano, Manabu Tsukada, Tsuyoshi Nemoto, Kazuhiro Kosugi, Yoshitaka Nishikawa, Shigeaki Kato, and Hiromichi Ohira.
• aDepartment of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan bTeikyo University Graduate School of Public Health, Tokyo, Japan cDepartment of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan dGlobal Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK eDepartment of Research, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan fDepartment of Home Medical Care, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan gDepartment of Palliative Care, Kawasaki Municipal Ida Hospital, Kawasaki, Kanagawa, Japan hDepartment of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan iResearch Institute of Innovative Medicine (RIIM), Tokiwa Foundation, Iwaki, Fukushima, Japan.
• Medicine (Baltimore). 2017 Nov 1; 96 (46): e8721.

RationaleThe primary setting of palliative care has shifted from inpatient care to patients' residences. Family caregiving is essential for patients with life-limiting illnesses to receive palliative care at home, however little information is available regarding potential interventions to achieve palliative homecare for those without sufficient support from family members in various settings, including disasters.Patient ConcernsIn March 2011, Fukushima, Japan experienced an earthquake, tsunami and nuclear disaster. In August 2015, a 59-year-old Japanese female presented to our hospital, located 23 km north of Fukushima Daiichi Nuclear Power Plant, with a right breast ulcer.DiagnosesThe patient was diagnosed with stage IV breast cancer.InterventionsThe patient's general condition gradually worsened despite a one-year course of chemotherapy, and she became bedridden after a fall in October 2016. Although the patient wished to receive palliative homecare, this appeared challenging to achieve because she resided alone in a temporary housing shelter. Although she originally lived with her family in Odaka District, Fukushima, she relocated outside of the city following evacuation orders after the disaster. The evacuation orders for Odaka District were still in effect when she returned to the city alone in 2014. We contacted her sister who moved apart from her during the evacuation, and explained the necessity of family caregiving to enable her palliative homecare.OutcomesThe sister decided to move back to their original residence in Odaka District and live with the patient again. The patient successfully spent her end-of-life period and died at home.LessonsHealth care providers and community health workers may need to take a pro-active approach to communicating with family members to draw informal support to enable patients' end-of-life management according to their values and preferences. This is a lesson which may be applicable to broader healthcare settings beyond cancer, or disaster contexts, considering that population ageing and social isolation may continue to advance worldwide.

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