• Akemi Yamagishi, Tatsuya Morita, Mitsunori Miyashita, Takayuki Ichikawa, Nobuya Akizuki, Yutaka Shirahige, Miki Akiyama, and Kenji Eguchi.
• Department of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka, Japan. ayamagishi-tky@umin.ac.jp
• J Pain Symptom Manage. 2012 Jan 1;43(1):59-67.

ContextThe role of general practitioners (GPs) and district nurses (DNs) is increasingly important to achieve dying at home.ObjectivesThe primary aim of this region-based representative study was to clarify 1) clinical exposure of GPs and DNs to cancer patients dying at home, 2) availability of symptom control procedures, 3) willingness to participate in out-of-hours cooperation and palliative care consultation services, and 4) reasons for hospital admission of terminally ill cancer patients.MethodsQuestionnaires were sent to 1106 GP clinics and 70 district nursing services in four areas across Japan.ResultsTwo hundred thirty-five GPs and 56 district nursing services responded. In total, 53% of GPs reported that they saw no cancer patients dying at home per year, and 40% had one to 10 such patients. In contrast, 31% of district nursing services cared for more than 10 cancer patients dying at home per year, and 59% had one to 10 such patients. Oral opioids, subcutaneous opioids, and subcutaneous haloperidol were available in more than 90% of district nursing services, whereas 35% of GPs reported that oral opioids were unavailable and 50% reported that subcutaneous opioids or haloperidol were unavailable. Sixty-seven percent of GPs and 93% of district nursing services were willing to use palliative care consultation services. Frequent reasons for admission were family burden of caregiving, unexpected change in physical condition, uncontrolled physical symptoms, and delirium.ConclusionJapanese GPs have little experience in caring for cancer patients dying at home, whereas DNs have more experience. To achieve quality palliative care programs for cancer patients at the regional level, educating GPs about opioids and psychiatric medications, easily available palliative care consultation services, systems to support home care technology, and coordinated systems to alleviate family burden is of importance.Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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