Yuki Kojima1, Nami Iwasaki2, Yuriko Yanaga3, Junko Tanuma4, Yusuke Koizumi5, Tomoko Uehira6, Mihoko Yotsumoto7, Atsushi Ajisawa8, Shotaro Hagiwara9, Seiji Okada10, Hirokazu Nagai11. 1. Department of Hematology and Oncology, Nagoya University Graduate school of Medicine, Nagoya, Japan Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. 2. Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. 3. Center for Infectious Disease and Infection Control, Keio University, Tokyo, Japan. 4. AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan. 5. Department of Hematology, Shiga University of Medical Science Hospital, Shiga, Japan. 6. Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan. 7. Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan. 8. Department of Infectious Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 9. Department of Hematology, Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan. 10. Center for AIDS Research, Kumamoto University, Kumamoto, Japan. 11. Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan nagaih@nnh.hosp.go.jp.
Abstract
BACKGROUND: The number of HIV-infected patients who require palliative or end-of-life care is increasing, and the status of end-of-life care for HIV patients with malignancies is unclear. AIM: This study aimed to evaluate the end-of-life care provided to HIV patients with malignancies in Japan. DESIGN: National cross-sectional questionnaire-based survey. SETTING/PARTICIPANTS: Questionnaires were delivered to the medical staff of 378 regional core hospitals/core hospitals for AIDS and 285 palliative care units in Japan. Data were collected between August and October 2013. RESULTS: Overall, 226 regional core hospitals/core hospitals for AIDS (59.8%) responded. A total of 55 institutions (24.3%) provided end-of-life care to HIV patients with malignancies. Regarding the place of death of the patients, 69.1% died at the institution whereas 18.2% were transferred to palliative care units. The requests of 16 (29.1%) institutions to transfer patients to palliative care units were rejected. Of the 378 palliative care units, 179 (62.8%) responded. While 13 palliative care units (4.6%) provided care to hospitalized HIV patients with malignancies, 20 (11.2%) refused to accept these patients for treatment because of a lack of experience in treating these patients and a lack of knowledge regarding HIV infection. CONCLUSION: Our findings suggest that in Japan, HIV patients with malignancies have difficulties obtaining hospitalization at a palliative care unit, which is likely due to a lack of experience among the professionals in treating such patients as well as a lack of knowledge about HIV.
BACKGROUND: The number of HIV-infectedpatients who require palliative or end-of-life care is increasing, and the status of end-of-life care for HIVpatients with malignancies is unclear. AIM: This study aimed to evaluate the end-of-life care provided to HIVpatients with malignancies in Japan. DESIGN: National cross-sectional questionnaire-based survey. SETTING/PARTICIPANTS: Questionnaires were delivered to the medical staff of 378 regional core hospitals/core hospitals for AIDS and 285 palliative care units in Japan. Data were collected between August and October 2013. RESULTS: Overall, 226 regional core hospitals/core hospitals for AIDS (59.8%) responded. A total of 55 institutions (24.3%) provided end-of-life care to HIVpatients with malignancies. Regarding the place of death of the patients, 69.1% died at the institution whereas 18.2% were transferred to palliative care units. The requests of 16 (29.1%) institutions to transfer patients to palliative care units were rejected. Of the 378 palliative care units, 179 (62.8%) responded. While 13 palliative care units (4.6%) provided care to hospitalized HIVpatients with malignancies, 20 (11.2%) refused to accept these patients for treatment because of a lack of experience in treating these patients and a lack of knowledge regarding HIV infection. CONCLUSION: Our findings suggest that in Japan, HIVpatients with malignancies have difficulties obtaining hospitalization at a palliative care unit, which is likely due to a lack of experience among the professionals in treating such patients as well as a lack of knowledge about HIV.