Palliative Care Team and Seirei Hospice, Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Curr Opin Support Palliat Care. 2013 Jun;7(2):207-15. doi: 10.1097/SPC.0b013e3283612241.
Providing palliative care in Japan is one of the most important health issues. Understanding palliative care delivery systems of other countries is useful when developing and modifying palliative care systems worldwide. This review summarizes the current status of palliative care in Japan, focusing on the structure and process development.
Palliative care units and hospital palliative care consultation teams are the two main specialized palliative care services in Japan. The number of palliative care units is 215 (involved in 8.4% of all cancer deaths), and there are approximately 500 hospital palliative care teams. Conversely, specialized home care services are one of the most undeveloped areas in Japan. However, the government has been trying to develop more efficient home care services through modifying laws, healthcare systems, and multiple educational and cooperative projects. The numbers of palliative care specialists are increasing across all disciplines: cancer pain nurses (1365), palliative care nurses (1100), palliative care physicians (646), and palliative care pharmacists (238). Postgraduate education for physicians is performed via the special nationwide efforts of the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) project - a 2-day program adopting a trainer-trainee strategy. Over 30,000 physicians have participated in the PEACE program. A total of 1298 and 544 physicians have completed a trainer course for palliative medicine and psycho-oncology, respectively. Multiple structure and process evaluation, bereaved family surveys in palliative care units, and patient and family evaluation in the regional palliative care program indicate many improvements.
Palliative care in Japan has progressed rapidly, and the Cancer Control Act has played a very important role in developing palliative medicine. Challenges include developing a structure for palliative care in the community or regional palliative care programs, establishing a method to measure and improve the quality of palliative care at a national level, developing evidence-based medicine and policy making, and palliative care for the noncancerous population.
在日本，提供姑息治疗是最重要的健康问题之一。了解其他国家的姑息治疗提供系统，对于在全球范围内开发和修改姑息治疗系统是有用的。本综述总结了日本姑息治疗的现状，重点介绍了结构和过程的发展。
日本有两种主要的专业姑息治疗服务，即姑息治疗病房和医院姑息治疗咨询团队。姑息治疗病房的数量为 215 个（涉及所有癌症死亡人数的 8.4%），约有 500 个医院姑息治疗团队。相反，专业的家庭护理服务是日本最不发达的领域之一。然而，政府一直在通过修改法律、医疗保健系统以及多项教育和合作项目，努力发展更有效的家庭护理服务。所有学科的姑息治疗专家人数都在增加：癌症疼痛护士（1365 人）、姑息治疗护士（1100 人）、姑息治疗医生（646 人）和姑息治疗药剂师（238 人）。通过专门的全国性努力，即姑息治疗重点计划症状管理和持续医学教育评估（PEACE）项目，对医生进行研究生教育，该项目采用培训师-培训生的策略，为期两天。超过 30000 名医生参加了 PEACE 项目。共有 1298 名和 544 名医生分别完成了姑息医学和心理肿瘤学培训师课程。姑息治疗病房的结构和过程评估、姑息治疗病房的丧亲家属调查以及区域姑息治疗计划中的患者和家属评估表明，许多方面都有所改善。
日本的姑息治疗发展迅速，《癌症控制法》在发展姑息医学方面发挥了非常重要的作用。面临的挑战包括在社区或区域姑息治疗计划中建立姑息治疗结构，建立在全国范围内衡量和提高姑息治疗质量的方法，制定循证医学和政策，以及为非癌症人群提供姑息治疗。
