Factors Involved in Shared Decision-making Regarding Treatment Selection by Patients With Cancer.

Background/Aim: Patients diagnosed with cancer are expected to choose one or more treatment modalities after receiving corresponding explanations of the options. When making these choices, patients consider the effects of treatment and aspects related to their quality of life. These concerns can cause confusion and conflict owing to the complicated information provided by medical caregivers. The objective of the study was to identify perceptions of cancer treatment in patients with cancer and the decision-making factors affecting their treatment choices. Patients and Methods: In this observational (cross-sectional) study, an online questionnaire survey was administered to 194 Japanese cancer patients with treatment experience. Patient information, perceptions of explanations provided by healthcare professionals, treatment views, and reasons for treatment decisions were subjected to a simple tabulation. Content and factor analysis was conducted to determine important treatment selection elements. Results: Regarding treatment perception, 60.3% of respondents (n=117) considered treatment a financial and family burden, 47.4% (n=92) had concerns about physical pain, and 40.2% (n=78) were worried about increased stress. Regarding decision-making quality, 95.9% determined their preferred treatment within one week, 49.0% reported difficulties in making their decisions, and 83.0% chose their treatment themselves. Major decisive factors were prolonging life, opinions of medical staff, and accepting treatment risks (68.0%, 68.6%, and 60.3% of patients, respectively). The main attitudes toward treatment were anxiety, expectations of benefit, and expectations of support and care. Conclusion: SDM should enable patients to visualize the changes that their bodies will experience and include discussions on prognosis. Psychological care should be prioritized to alleviate anxiety and improve readiness for decision-making; attention should be paid to the extent and timing of information provision.

Actual situation of decision-making support from medical staff when cancer patients make treatment choices.

Background: We investigated factors involved in decision-making support provided by physicians, nurses, pharmacists and medical and psychiatric social workers involved in cancer care. Materials & methods: A questionnaire survey on decision-making support was conducted. The level of clinician support was classified as 'supporting patients' 'decision-making process regarding cancer treatment', 'no support for patients' 'decision-making process regarding cancer treatment' or 'team-based support for patients' 'decision-making process regarding cancer treatment'. Results: Physicians estimated that 83.7% of patients made a cancer treatment decision within 1 week, but 45.4% of patients had difficulty making a decision. Conclusion: Medical personnel should support patients who have difficulty making decisions, establish a screening method to identify those needing support and develop a system providing decision-making support through interprofessional work.

We conducted a survey to investigate issues related to the level of decision-making support provided by physicians, nurses, pharmacists medical social workers and psychiatric social workers involved in cancer care. The physicians reported that 83.7% of patients with cancer chose a treatment plan within 1 week, although 45.4% of patients had difficulty making a decision. These decision-making difficulties arose at the time of diagnosis, when having difficulty controlling adverse events and when cancer metastasis or recurrence occurred. Some medical providers supported patients who had particular difficulty in choosing their cancer treatment, others provided no support, while a third group orchestrated a team to support them in their decision-making. To improve the quality of decision-making support, interprofessional work should be promoted and screening tools to identify those who need support should be established.

Factors and Challenges in Increasing the Utilization Rate of a New Long-term Care Service (Kantaki) in a Superaging Society: Cross-sectional Study.

BACKGROUND: Japan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue. OBJECTIVE: This study aimed to determine factors influencing the utilization rate of Kantaki facilities. METHODS: This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate. RESULTS: Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki's profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki's profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related. CONCLUSIONS: To improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system's design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.

Bone Tunnel Placement Determination Method for 3D Images and Its Evaluation for Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Anterior cruciate ligament (ACL) injury causes knee instability which affects sports activity involving cutting and twisting motions. The ACL reconstruction surgery replaces the damaged ACL with artificial one which is fixed to the bone tunnels opened by the surgeon. The outcome of the ACL reconstruction is strongly related to the placement of the bone tunnels, therefore, the optimization of tunnel drilling technique is an important factor to obtain satisfactory surgical results. AIMS: The quadrant method is used for the post-operative evaluation of the ACL reconstruction surgery, which evaluates the bone tunnel opening sites on the lateral 2D X-ray radiograph. METHODS: For the purpose of applying the quadrant method to the pre-operative knee MRI, we have synthesized the pseudo lateral 2D X-ray radiograph from the patients' knee MRI. This paper proposes a computer-aided surgical planning system for the ACL reconstruction. The proposed system estimates appropriate bone tunnel opening sites on the pseudo lateral 2D X-ray radiograph synthesized from the pre-operative knee MRI. RESULTS: In the experiment, the proposed method was applied to 98 subjects including subjects with osteoarthritis. The experimental results showed that the proposed method can estimate the bone tunnel opening sites accurately. The other experiment using 36 healthy patients showed that the proposed method is robust to the knee shape deformation caused by disease. CONCLUSION: It is verified that the proposed method can be applied to subjects with osteoarthritis.

Spatiotemporal Statistical Shape Model for Temporal Shape Change Analysis of Adult Brain.

BACKGROUND: This study presents a novel method of constructing a spatiotemporal statistical shape model (st-SSM) for adult brain. St-SSM is an extension of statistical shape model (SSM) in the temporal domain which will represent the statistical variability of shape as well as the temporal change of statistical variance with respect to time. AIMS: Expectation-Maximization (EM) based weighted principal component analysis (WPCA) using a temporal weight function is applied where the eigenvalues of each data are estimated by Estep using temporal eigenvectors, and M-step updates Eigenvectors in order to maximize the variance. Both E and M-step are iterated until updating vectors reaches the convergence point. A weight parameter for each subject is allocated in accordance with the subject's age to calculate the weighted variance. A Gaussian function is utilized to define the weight function. The center of the function is a time point while the variance is a predefined parameter. METHODS: The proposed method constructs adult brain st-SSM by changing the time point between minimum to maximum age range with a small interval. Here, the eigenvectors changes with aging. The feature vector of representing adult brain shape is extracted through a level set algorithm. To validate the method, this study employed 103 adult subjects (age: 22 to 93 y.o. with Mean ± SD = 59.32±16.89) from OASIS database. st-SSM was constructed for time point 40 to 90 with a step of 2. RESULTS: We calculated the temporal deformation change between two-time points and evaluated the corresponding difference to investigate the influence of analysis parameter. An application of the proposed model is also introduced which involves Alzheimer's disease (AD) identification utilizing support vector machine. CONCLUSION: In this study, st-SSM based adult brain shape feature extraction and classification techniques are introduced to classify between normal and AD subject as an application.