When should Home-visit nurses initiate end-of-life discussions for patients with Organ failure and family caregivers? A qualitative study.

BACKGROUND: End-of-life (EOL) discussions for organ-failure patients with family caregivers are important factors for successful EOL care. However, identifying the appropriate time to initiate these discussions is difficult owing to the unpredictability of the disease trajectory. No practical tools or clinical indicators currently exist that can help identify non-cancer patients receiving home care who need EOL discussions. METHODS: The survey was conducted from February 2020 to June 2021. To identify the appropriate time at which to initiate EOL discussions for patients with organ failure and their caregivers, we determined the time when home-visit nurses initiated EOL discussions. We interviewed 19 home-visit nurses (mean total home-visit nursing experience: 6.7 ± 5.9 years) and analyzed the data using Hsieh and Shannon's qualitative content approach. RESULTS: Three themes related to home-visit nurses' experiences of identifying the appropriate time to start EOL discussions were identified: symptomatic worsening, lack of patients' and family caregivers' EOL awareness, and decline in activities of daily living. CONCLUSIONS: It is necessary to develop a tool that will enable home-visit nurses to implement EOL discussions at the appropriate time.

[Regorafenib and Trifluridine and Tipiracil Hydrochloride Can Potentially Improve the Survival Time for Patients with Advanced or Recurrent Colorectal Cancer].

Regorafenib and trifluridine and tipiracil hydrochloride(TFTD)have been recently used for the treatment of advanced or recurrent colorectal cancer during or after the third-line therapy. These drugs are expected to prolong survival. The progression- free survival period associated with each drug in clinical trials is known to be less than 2 months. However, reports on the overall survival in the sequential therapy with these drugs have been limited. In our institution, sequential therapy using regorafenib and TFTD has achieved longer median survival time(MST)than the previously reported. The MST with monotherapy and sequential therapy was 37 and 45 months, respectively. We currently have a patient who has not had cancer progression for 3 years and 6 months with monotherapy. Regorafenib and TFTD can potentially improve the survival time beyond our observations on monotherapy when used at the appropriate time and with a thorough understanding of their adverse effects.

Timely Identification of Patients With Cancer and Family Caregivers in Need of End-of-Life Discussions by Home-Visit Nurses in Japan: A Qualitative Descriptive Study.

End-of-life (EOL) discussions for patients with cancer are a key factor of successful EOL care; however, identifying the optimal timing for these discussions in Japanese home-care settings is difficult. To identify the time at which patients with cancer and their caregivers need EOL discussions, we explored when home-visit nurses start EOL discussions. We interviewed 23 home-visit nurses and analyzed the data using qualitative content analysis. Three themes were derived from the analysis. Participants identified the timing of EOL discussions as being sensitive to patients' changing health and care needs (increases in patient's total pain), changes in the family caregiver's physical or mental condition through daily care (increases in family caregiver distress), and the EOL process that patients follow (trajectory of disease). Developing a tool or in-service educational program that will enable inexperienced or new graduate home-visit nurses to implement EOL discussions at appropriate times is necessary.