Published papers

This study was designed to evaluate the psychometric properties of the newly completed Japanese translation of the Ferrans and Powers Quality of Life Index Cancer Version III (QLI). Using a cross-sectional descriptive design, 136 ambulatory patients with gastrointestinal cancer (55 receiving chemotherapy, 76 with stable health status after treatment, and five status not known) completed a questionnaire at a one-time point, and 26 patients (stable health status) completed the questionnaire again 2 weeks later. Internal consistency reliability was supported by Cronbach's α of.96 for the total scale, with subscales ranging from.83 to.93. A test–retest correlation of 0.76 (total scale) provided evidence of stability reliability over a 2-week period, with subscale retest correlations ranging from 0.70 to 0.83. Confirmatory factor analysis showed the same four domains for the Japanese translation as the original QLI, supporting construct validity. We also assessed construct validity by examining the relationships between the Japanese QLI and six other concepts known to be related to the quality of life. As hypothesized, all correlations were moderate and in the expected direction (pain −0.39, anxiety −0.54, depression −0.63, stress −0.51, pain interfering with functioning −0.52, and general health 0.62). This evidence of the reliability and validity of the Japanese translation of the QLI supports its use in research and clinical practice to evaluate the impact of cancer and treatment. This new translation can be used to assess the patient's perspective of their quality of life, both within Japan and in cross-cultural studies with the QLI in other languages.

The COVID-19 pandemic highlighted the need for advance care planning (ACP) as a way to help mitigate the various care concerns that accompanied the healthcare crisis. However, unique obstacles to typical ACP practice necessitated the need for guidance and innovation to help facilitate these vital conversations. The aim of this systematic review was to identify the various ACP barriers and facilitators that arose during the pandemic and determine how ACP practice was affected across different contexts and among different populations. This systematic review (PROSPERO registration number: CRD42022359092), which adheres to the PRISMA guidelines for reporting systematic reviews, examined studies on ACP in the context of the COVID-19 pandemic. The review involved searches of five databases, including MEDLINE and Embase. Of the 843 identified studies, 115 met the inclusion criteria. The extracted ACP barriers and facilitators were codified and quantified. The most frequently occurring ACP barrier codes were: Social distancing measures and visitation restrictions, Uncertainty surrounding the COVID-19 prognosis, and Technological/Telehealth barriers. The most frequently occurring ACP facilitator codes were the following: Telehealth/virtual ACP platforms, Training for clinicians, and Care team collaboration. Identifying the ACP barriers and facilitators is essential for developing effective, resilient ACP promotion strategies and improving its delivery, accessibility, and acceptability.

Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat that reduces antibiotic effectiveness and increases healthcare burdens. Countries in the Asia–Pacific region face a particularly high AMR burden, necessitating international collaboration, education, and practical training to combat this growing crisis. This study describes the design, implementation, and educational outcomes of the Infection Diagnosis Workshop, a short-term international program primarily targeting undergraduate medical sciences students that integrates AMR-focused hands-on clinical microbiology training and lectures, alongside cross-cultural collaboration and scientific English communication. Methods: The Infection Diagnosis Workshop was implemented as a four-day program combining lectures with hands-on laboratory activities. Training emphasizes the detection and analysis of antibiotic-resistant bacteria through environmental sampling, bacterial culturing, phenotypic and genotypic resistance detection, and species identification, core components that have remained consistent since the workshop’s establishment. Students also attended lectures on AMR science, global impact, and management strategies. Group discussions and collaborative tasks encouraged interdisciplinary learning. A thematic analysis of student feedback essays from previous workshop cohorts was conducted to identify key concepts, learning outcomes, and shared experiences. All participants provided informed consent for the use of their written feedback. Results: Thematic analysis revealed key learning outcomes categorized into three themes: (1) Knowledge, Awareness, and Technical Skills; (2) Cultural Understanding and Cross-Cultural Collaboration; and (3) English Language and Communication Skills. Students reported increased AMR knowledge, improved laboratory proficiency, enhanced cultural adaptability, and greater confidence in English communication. They also expressed a deeper appreciation for interdisciplinary and international approaches to AMR. Conclusions: The Infection Diagnosis Workshop effectively integrated practical laboratory training with international and cross-cultural engagement. The program strengthened student competencies and contributed to building global partnerships essential for combating AMR.

Objective The COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of ACP implementation for medical staff in different settings (eg, hospitals, outpatient palliative care, nursing and care homes) during the pandemic. Design This study employed an overview of reviews design. We searched the MEDLINE, CENTRAL, Web of Science and Embase databases for studies published between 8 December 2019 and 30 July 2023. We used AMSTAR 2 to assess the risk of bias. Results We included seven reviews. Common barriers to ACP implementation included visitation restrictions, limited resources and personnel and a lack of coordination among healthcare professionals. In care and nursing homes, barriers included a dearth of palliative care physicians and the psychological burden on facility staff. Using telemedicine for information sharing was a common facilitator across settings. In hospitals, facilitators included short-term training in palliative care and palliative care physicians joining the acute care team. In care and nursing homes, facilitators included ACP education and emotional support for staff. Conclusions Visitation restrictions and limited resources during the pandemic posed obstacles; however, the implementation of ACP was further hindered by insufficient staff education on ACP in hospitals and facilities, as well as a scarcity of information sharing at the community level. These pre-existing issues were magnified by the pandemic, drawing attention to their significance. Short-term staff training programmes and immediate information sharing could better enable ACP. PROSPERO registration number CRD42022351362.

Context: The factors associated with end-of-life discussion (EOLD) are not well elucidated; an understanding of these factors may help facilitate EOLD. Objectives: To investigate the associations between EOLD and experiences of the death of and/or care for a loved one and other factors. Methods: Data from a nationwide anonymous questionnaire survey of public attitudes toward end-of-life medical care, conducted in December 2017 in Japan, were used. Participants were randomly selected from the general population (age ≥ 20 years), and respondents who completed the questionnaire were analyzed (respondents: n = 836; effective response rate: 13.9%). Respondents were divided into two groups based on their experience of EOLD: those who had engaged in EOLD and those who had not. The main predictors were the experiences of the death of and care for a loved one. Multivariable logistic regression analyses were performed. Results: Of the 836 respondents (male: 55.6%, aged 65 and over: 43.5%), 43.7% reported their engagement in EOLD. In the analyses, “having experience of caring for a loved one” was associated with EOLD compared with never having experience (odds ratio 1.88, 95% confidence interval 1.35–2.64). However, having experience of the death of a loved one had no association. Conclusion: For health-care providers, it may be worth recognizing that the care experience of their patient's caregiver might affect the caregiver's own EOLD in the future.