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clinical nurse specialist, home visits, integrated community care system, outreach, palliative home care, place of death



  1. Takashima, Rumi BS, RN, CNPC
  2. Tanabe, Kouichi PhD, JSOP, BCPPP, IDCP, s-HIT
  3. Morita, Tatsuya MD
  4. Amemiya, Yoko BS, RN
  5. Fujikawa, Yasunaga BS, MSW
  6. Yasuda, Hatsuna BA
  7. Kashii, Tatsuhiko PhD, MD
  8. Murakami, Nozomu PhD, MD


This study aimed to provide a basis for appropriate home care for cancer patients by clarifying the usefulness of home visits in a collaboration program between visiting and certified hospital nurses. This was a mixed-methods study. (1) A quantitative study was conducted, involving all patients referred to the palliative care team, and (2) a questionnaire survey was conducted, involving 40 visiting nurses. In the study (1), the subjects were all patients who were referred to a palliative care team before (October 2010 to March 2012; control group) and after (April 2012 to September 2013; collaborative home visit group) the initiation of collaborative home visits. After the patients underwent observation through December 2013, their data from charts, as of January 2014, were obtained. The proportion of home deaths increased by 3.8%, from 58.3% (n = 14) to 62.1% (n = 18), after the initiation of collaborative home visits; this increase was not significant (P = .78). However, in the survey (2), visiting nurses' sense of difficulty in providing palliative home care was significantly reduced in comparison between those with and without experience of such visits (P = .013). Visiting nurses' reduced sense of difficulty in providing palliative home care after collaboration during home visits suggests the usefulness of such collaboration for them. This program may contribute to increases in the proportion of home deaths by increasing the numbers of nurses newly engaged in palliative home care.