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Factors associated with good death of patients with advanced cancer: a prospective study in Japan

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Abstract

Purpose

It is important for palliative care providers to identify what factors are associated with a “good death” for patients with advanced cancer. We aimed to identify factors associated with a “good death” evaluated by the Good Death Scale (GDS) score among inpatients with advanced cancer in palliative care units (PCUs) in Japan.

Methods

The study is a sub-analysis of a multicenter prospective cohort study conducted in Japan. All variables were recorded on a structured data collecting sheet designed for the study. We classified each patient into better GDS group or worse GDS group, and examined factors associated with better GDS using multivariate analysis.

Results

Between January and December 2017, 1896 patients were enrolled across 22 PCUs in Japan. Among them, a total of 1157 patients were evaluated. Five variables were significantly associated with a better GDS score in multivariate analysis: preferred place of death at PCU (odds ratio [OR] 2.85; 95% confidence interval [CI] 1.72–4.71; p < 0.01), longer survival time (OR 1.02; 95% CI 1.00–1.03; p < 0.01), not sudden death (OR 1.96; 95% CI 1.27–3.04; p < 0.01), better spiritual well-being in the last 3 days in life (OR 0.53; 95% CI 0.42–0.68; p < 0.01), and better communication between patient and family (OR 0.81; 95% CI 0.66–0.98; p = 0.03).

Conclusions

We identified factors associated with a “good death” using GDS among advanced cancer patients in Japanese PCUs. Recognition of factors associated with GDS could help to improve the quality of end-of-life care.

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Abbreviations

(CCS):

Communication Capacity Scale

(CI):

Confidence interval

(DRS-R-98):

Delirium Rating Scale-revised-98

(EASED):

East-Asian collaborative cross-cultural Study to Elucidate the Dying Process

(ECOG PS):

Eastern Cooperative Oncology Group performance status

(GDI):

Good Death Inventory

(GDS):

Good Death Scale

(IPOS):

Integrated Palliative Outcome Scale

(STAS-J):

Japanese version of STAS

(MDAS):

Memorial Delirium Assessment Scale

(OR):

Odds ratio

(PCU):

Palliative care unit

(QOD):

Quality of dying

(STAS):

Support Team Assessment Schedule

(SWB):

Spiritual well-being

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing. This study was performed in the East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED). The participating study sites and site investigators in Japan were as follows: Satoshi Inoue, M.D. (Seirei Hospice, Seirei Mikatahara General Hospital), Naosuke Yokomichi, M.D., Ph.D. (Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital), Kengo Imai, M.D. (Seirei Hospice, Seirei Mikatahara General Hospital), Tatsuya Morita, M.D. (Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital), Hiroaki Tsukuura, M.D., Ph.D. (Department of Palliative Care, TUMS Urayasu Hospital), Toshihiro Yamauchi, M.D. (Seirei Hospice, Seirei Mikatahara General Hospital), Akemi Shirado Naito, M.D. (Department of palliative care Miyazaki Medical Association Hospital), Akira Yoshioka, M.D., Ph.D. (Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital), Shuji Hiramoto, M.D. (Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital), Ayako Kikuchi, M.D. (Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital), Tetsuo Hori, M.D. (Department of Respiratory surgery, Mitsubishi Kyoto Hospital), Hiroyuki Kohara, M.D., Ph.D. (Hiroshima Prefectural Hospital), Hiromi Funaki, M.D. (Hiroshima Prefectural Hospital), Keiko Tanaka, M.D., Ph.D. (Department of Palliative Care Tokyo Metropolitan Cancer & Infectious Diseases Center Komagome Hospital), Kozue Suzuki, M.D. (Department of Palliative Care Tokyo Metropolitan Cancer & Infectious Diseases Center Komagome Hospital), Tina Kamei, M.D. (Department of Palliative Care, NTT Medical Center Tokyo), Yukari Azuma, M.D. (Home Care Clinic Aozora Shin-Matsudo), Teruaki Uno, M.D. (Department of Palliative Medicine, Osaka City General Hospital), Jiro Miyamoto, M.D. (Department of Palliative Medicine, Osaka City General Hospital), Hirofumi Katayama, M.D. (Department of Palliative Medicine, Osaka City General Hospital), Hideyuki Kashiwagi, M.D., MBA. (Aso Iizuka Hospital / Transitional and Palliative Care), Eri Matsumoto, M.D. (Aso Iizuka Hospital / Transitional and Palliative Care), Takeya Yamaguchi, M.D. (Japan Community Health care Organization Kyushu Hospital / Palliative Care), Tomonao Okamura, M.D., MBA. (Aso Iizuka Hospital / Transitional and Palliative Care), Hoshu Hashimoto, M.D., MBA. (Inoue Hospital / Internal Medicine), Shunsuke Kosugi, M.D. (Department of General Internal Medicine, Aso Iizuka Hospital), Nao Ikuta, M.D. (Department of Emergency Medicine, Osaka Red Cross Hospital), Yaichiro Matsumoto, M.D. (Department of Transitional and Palliative Care, Aso Iizuka Hospital), Takashi Ohmori, M.D. (Department of Transitional and Palliative Care, Aso Iizuka Hospital), Takehiro Nakai, M.D. (Immuno-Rheumatology Center, St Luke's International Hospital), Takashi Ikee, M.D. (Department of Cardiorogy, Aso Iizuka Hospital), Yuto Unoki, M.D. (Department of General Internal Medicine, Aso Iizuka Hospital), Kazuki Kitade, M.D. (Department of Orthopedic Surgery, Saga-Ken Medical Centre Koseikan), Shu Koito, M.D. (Department of General Internal Medicine, Aso Iizuka Hospital), Nanao Ishibashi, M.D. (Environmental Health and Safety Division, Environmental Health Department, Ministry of the Environment), Masaya Ehara, M.D. (TOSHIBA), Kosuke Kuwahara, M.D. (Department of General Internal Medicine, Aso Iizuka Hospital), Shohei Ueno, M.D. (Department of Hematology / Oncology, Japan Community Healthcare Organization Kyushu Hospital), Shunsuke Nakashima, M.D. (Oshima Clinic), Yuta Ishiyama, M.D. (Department of Transitional and Palliative Care, Aso Iizuka Hospital), Akihiro Sakashita, M.D., Ph.D. (Department of Palliative Medicine, Kobe University School of Medicine), Ryo Matsunuma, M.D. (Department of Palliative Medicine, Kobe University Graduate School of Medicine), Hana Takatsu, M.D. (Division of Palliative Care, Konan Medical Center), Takashi Yamaguchi, M.D., Ph.D. (Division of Palliative Care, Konan Medical Center), Satoko Ito, M.D. (Hospice, The Japan Baptist Hospital), Toru Terabayashi, M.D. (Hospice, The Japan Baptist Hospital), Jun Nakagawa, M.D. (Hospice, The Japan Baptist Hospital), Tetsuya Yamagiwa, M.D., Ph.D. (Hospice, The Japan Baptist Hospital), Akira Inoue, M.D., Ph.D. (Department of Palliative Medicine Tohoku University School of Medicine), Mitsunori Miyashita, R.N., Ph.D. (Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine), Saran Yoshida, Ph.D. (Graduate School of Education, Tohoku University), Hiroaki Watanabe, M.D. (Department of Palliative Care, Komaki City Hospital), Takuya Odagiri, M.D. (Department of Palliative Care, Komaki City Hospital), Tetsuya Ito, M.D.,Ph.D. (Department of Palliative Care, Japanese Red Cross Medical Center), Masayuki Ikenaga, M.D. (Hospice, Yodogawa Christian Hospital), Keiji Shimizu, M.D., Ph.D. (Department of Palliative Care Internal Medicine, Osaka General Hospital of West Japan Railway Company), Akira Hayakawa, M.D., Ph.D. (Hospice, Yodogawa Christian Hospital), Rena Kamura, M.D. (Hospice, Yodogawa Christian Hospital), Takeru Okoshi, M.D., Ph.D. (Okoshi Nagominomori Clinic), Tomohiro Nishi, M.D. (Kawasaki Municipal Ida Hospital, Kawasaki Comprehensive Care Center), Kazuhiro Kosugi, M.D. (Department of Palliative Medicine, National Cancer Center Hospital East), Yasuhiro Shibata, M.D. (Kawasaki Municipal Ida Hospital, Kawasaki Comprehensive Care Center), Takayuki Hisanaga, M.D. (Department of Palliative Medicine, Tsukuba Medical Center Hospital), Takahiro Higashibata, M.D., Ph.D. (Department of General Medicine and Primary Care, Palliative Care Team, University of Tsukuba Hospital), Ritsuko Yabuki, M.D. (Department of Palliative Medicine, Tsukuba Medical Center Hospital), Shingo Hagiwara, M.D., Ph.D. (Department of Palliative Medicine, Yuai Memorial Hospital), Miho Shimokawa, M.D. (Department of Palliative Medicine, Tsukuba Medical Center Hospital), Satoshi Miyake, M.D., Ph.D. (Professor, Department of Clinical Oncology Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University (TMDU)), Junko Nozato, M.D. (Specially Appointed Assistant Professor, Department of Internal Medicine, Palliative Care, Medical Hospital, Tokyo Medical and Dental University), Hiroto Ishiki, M.D. (Department of Palliative Medicine, National Cancer Center Hospital), Tetsuji Iriyama, M.D. (Specially Appointed Assistant Professor, Department of Internal Medicine, Palliative Care, Medical Hospital, Tokyo Medical and Dental University), Keisuke Kaneishi, M.D., Ph.D. (Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center), Mika Baba, M.D., Ph.D. (Department of Palliative medicine Suita Tokushukai Hospital), Tomofumi Miura, M.D., Ph.D. (Department of Palliative Medicine, National Cancer Center Hospital East), Yoshihisa Matsumoto, M.D., Ph.D. (Department of Palliative Medicine, National Cancer Center Hospital East), Ayumi Okizaki, Ph.D. (Department of Palliative Medicine, National Cancer Center Hospital East), Yuki Sumazaki Watanabe, M.D. (Department of Palliative Medicine, National Cancer Center Hospital East), Yuko uehara, M.D. (Department of Palliative Medicine, National Cancer Center Hospital East), Eriko Satomi, M.D. (Department of palliative medicine, National Cancer Center Hospital), Kaoru Nishijima, M.D. (Department of Palliative Medicine, Kobe University Graduate School of Medicine), Junichi Shimoinaba, M.D. (Department of Hospice Palliative Care, Eikoh Hospital), Ryoichi Nakahori, M.D. (Department of Palliative Care, Fukuoka Minato Home Medical Care Clinic), Takeshi Hirohashi, M.D. (Eiju General Hospital), Jun Hamano, M.D., Ph.D. (Assistant Professor, Faculty of Medicine, University of Tsukuba), Natsuki Kawashima, M.D. (Department of Palliative Medicine, Tsukuba Medical Center Hospital), Takashi Kawaguchi, Ph.D. (Tokyo University of Pharmacy and Life Sciences Department of Practical Pharmacy), Megumi Uchida, M.D., Ph.D. (Dept. of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences), Ko Sato, M.D., Ph.D. (Hospice, Ise Municipal General Hospital), Yoichi Matsuda, M.D., Ph.D. (Department of Anesthesiology & Intensive Care Medicine / Osaka University Graduate School of Medicine), Yutaka Hatano, M.D., Ph.D. (Hospice, Gratia Hospital), Satoru Tsuneto, M.D., Ph.D. (Professor, Department of Human Health Sciences, Graduate School of Medicine, Kyoto University Department of Palliative Medicine, Kyoto University Hospital), Sayaka Maeda, M.D. (Department of Palliative Medicine, Kyoto University Hospital), Yoshiyuki Kizawa M.D., Ph.D., FJSIM, DSBPMJ. (Designated Professor and Chair, Department of Palliative Medicine, Kobe University School of Medicine), Hiroyuki Otani, M.D. (Palliative Care Team, and Palliative and Supportive Care, National Kyushu Cancer Center), Isseki Maeda, MD., Ph.D. (Department of Palliative Care, Senri-Chuo Hospital).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Tomoo Ikari

  2. Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan

    Tomoo Ikari, Yusuke Hiratsuka & Akira Inoue

  3. Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan

    Yusuke Hiratsuka

  4. Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan

    Shao-Yi Cheng

  5. Department of Palliative Nursing, Tohoku University School of Medicine, Sendai, Japan

    Mitsunori Miyashita

  6. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan

    Tatsuya Morita & Masanori Mori

  7. Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Yu Uneno

  8. Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan

    Koji Amano

  9. Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan

    Yuko Uehara

  10. Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Yuko Uehara

  11. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Takashi Yamaguchi

  12. Department of Palliative Care Senri-Chuo Hospital, Toyonaka, Japan

    Isseki Maeda

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  1. Tomoo Ikari
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  2. Yusuke Hiratsuka
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  4. Mitsunori Miyashita
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  12. Akira Inoue
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Contributions

Tomoo Ikari: conceptualization, project implementation writing draft, and writing review and editing.

Yusuke Hiratsuka: conceptualization, project administration, formal analysis, data curation, methodology, investigation, writing draft, and writing review and editing.

Shao-Yi Cheng: investigation, supervision and writing review and editing.

Mitsunori Miyashita: supervision and writing review and editing.

Tatsuya Morita: investigation, supervision and writing review and editing.

Masanori Mori: conceptualization, investigation, methodology, project administration, resources, supervision, and writing review and editing.

Yu Uneno: investigation and writing review and editing.

Koji Amano: investigation and writing review and editing.

Yuko Uehara: investigation and writing review and editing.

Takashi Yamaguchi: investigation and writing review and editing.

Isseki Maeda: investigation and writing review and editing.

Akira Inoue: investigation and writing review and editing.

Corresponding author

Correspondence to Yusuke Hiratsuka.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

This study was conducted in accordance with the ethical standards of the Declaration of Helsinki. The ethical guidelines for medical and health research involving human subjects presented by the Japanese Ministry of Health, Labor, and Welfare, and were approved by the local Institutional Review Boards of all participating institutions. Japanese law does not require individual informed consent from participants in a non-invasive observational trial such as the present study.

Consent to participate

We used an opt-out method rather than acquiring written or oral informed consent; all patients could find information on the study through the instructions posted on the ward or institutional website, and they had the opportunity to decline participation.

Consent for publication

All authors read and approved the final manuscript.

Conflict of interest

The authors declare no competing interests.

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Key message

The multicenter prospective cohort study identified five factors associated with good death in patients admitted to palliative care units; preferred place of death at palliative care units, longer survival time, not sudden death, better spiritual well-being in the last 3 days in life, and better communication between patient and family.

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Ikari, T., Hiratsuka, Y., Cheng, SY. et al. Factors associated with good death of patients with advanced cancer: a prospective study in Japan. Support Care Cancer 30, 9577–9586 (2022). https://doi.org/10.1007/s00520-022-07363-1

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