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.

Research trends of oncology nursing in Japan and around the world.

This article reviews recent cancer nursing research in Japan and the USA, and topics relating to international cancer nursing societies. Most of the articles on cancer nursing published in Japan are in the Journal of the Japanese Society of Cancer Nursing. A total of 46 articles have been published over 3 years from 2009, and many of these are qualitative studies aimed at understanding the response of cancer patients to disease along with their symptoms and backgrounds. The International Society of Nurses in Cancer Care (ISNCC) holds a conference biennially, at which cancer nursing research is presented by researchers from around the world. Many pieces of research on the topics of the symptomatic management and health impact of smoking and cancer screening are discussed. Also, at the Congress of the Oncology Nursing Society (ONS), the world's largest cancer nursing society in the USA, a nation advanced in the field of cancer nursing, symptomatic management has already been discussed; however, the topics have been shifting from nausea, vomiting and pain to adverse events induced by novel treatments such as skin alterations, peripheral neuropathy and fatigue. Cancer nursing research is not yet fully mature in terms of the number and range of articles. In nursing research, it is difficult to measure a patient's response to their disease because it includes psychosocial response; the results are difficult to claim as scientific evidence. Therefore, it is still necessary to conduct research with detailed descriptions of clinical phenomena and to develop cancer nursing research, including actual study methodologies.

Evaluating the self-care agency of patients receiving outpatient chemotherapy.

Dramatic advances have been made in cancer treatment in recent years, enabling patients to leave the hospital more quickly and stay home while still undergoing treatment. As a result, the percentage of outpatients has been on the rise. Healthcare providers engaged in actual outpatient treatment, however, spend so much energy implementing daily procedures safely that they have little time remaining to provide patient education or carry out any other systematic patient support programs. Although self-care generally is believed to be what people do to help themselves, differences exist between Western countries and Japan in the interpretation of self-care. In Japan, obtaining necessary support from the family and friends that one relies on also is viewed as essential. Patients' self-care agency must be assessed if nurses are to make the most of patients' abilities; however, evaluation criteria for that purpose have yet to be established. Development of a method for evaluating the self-care agency of patients receiving chemotherapy on an outpatient basis is needed to ensure further advancement in this area of nursing.

Development of nursing care quality improvement system on website in Japan.

A model for measuring the quality of nursing care has been developed in Japan since 1993 by Katada. Then a self evaluation model was developed in 2002 by Abe et al. This model consisted of three dimensions: structure, process, and outcome. Each dimension was constructed from measurements of six domains which applicants categorized previously, such as "understanding individuality", "patient empowerment", "family care", "direct care", "medical team coordination", and "incident prevention" In this study, it has been developed and posted on a web site for inspection and examined for its usability.

Distribution of care information packages for the support of patients with cancer and their families during disaster situations and their evaluation via the internet.

With the aim of preparing for disasters, care information packages for the support of patients with cancer and their families during disaster situations were developed in our previous study, and were provided via the internet with a questionnaire asking the face validity and the usefulness of such information. Thirty replies were received. Most subjects thought the care packages were appropriate and useful in the actual settings, however 43.3% of them thought the amount of information was excessive. Many comments and suggestions on the care information packages also could be obtained via the internet.