Abstract
Dear Editor:
Transition from hospital to home in cancer care is a difficult task. Construction of a regional collaboration system is a pressing issue in Japan. 1 Poor understanding between hospital and home-care staff has been reported as a barrier in the regional collaboration system. 2 Family conferences before discharge are recommended in cases of transition to home in Japan.3,4
From 2012 to 2015, we introduced a role playing of the predischarge conference to workshops of regional palliative care in accordance with guidelines of the Japan Ministry of Health, Labour and Welfare. We set the multiplayer role playing as a structured conference to simulate a flow to home care through a case of terminal cancer with bone metastases. To take a brief period of preparing, patient–family side had a meeting about concerns as patients and family members. Medical staff side was given a role, such as visiting doctor, visiting nurse, hospital physician, and hospital nurse. Medical side had a meeting about concerns as a home visiting service. Roles of moderator, secretary, and presentation speaker made effort for a consensus of each side. Then the structured conference was actually held along a scenario, including issues such as goal set of home care, symptom relief, handling of the sudden symptoms change, round-the-clock contact, and ensuring of the hospital backup. In the feedback section, both patient–family and medical staff sides quit roles to share their experience and discuss that actually required before discharge.
To measure the experience and self-achievement, a questionnaire survey in five-point scale was conducted after the session. Number of participating healthcare workers is 118 (doctors 87, nurses 26, pharmacists 5). The median period of engagement in healthcare was five years (1–30). Proportion of participants with the home care experience was 7%, whose median duration of experience was three years (1–4).
In post-session questionnaire, the percentages who answered “I think very well” and “I think well” were as follows: “predischarge conference can contribute to anxiety reduction of the patient and family,” 89%; “I learned support methods in case of anxiety expression from family,” 80%; “I could increase ability of setting goals for symptom management,” 76%; “I could increase information of home-based palliative care for cancer patients,” 68%; and “I want to participate in conferences and workshops of regional palliative care,” 64%.
The majority of participants agreed that the predischarge conference could contribute to reduce anxiety, suggesting that it may be possible to simulate the patient and family experience and realize the benefit of predischarge conference. In this session, an awareness of the issues that should be shared among the medical professions at the time of discharge may contribute to the unbroken partnership of regional palliative care. Multiplayer role playing, including the perspectives of patient–family and medical staff, may be useful to consider better regional palliative care. This study has limitations on the experience of a single regional cancer center at a relatively resource-rich prefectural capita. Further study is needed to improve the educational effectiveness of the regional palliative care session.