Diagnostic models for impending death in terminally-ill cancer patients: A multicenter cohort study.

• Project/Area Number: 16K15418
• Research Category: Grant-in-Aid for Challenging Exploratory Research
• Allocation Type: Multi-year Fund
• Research Field: General internal medicine(including psychosomatic medicine)
• Research Institution: Seirei Christopher University
• Principal Investigator: Mori Masanori 聖隷クリストファー大学, 看護学研究科, 臨床講師 (10771868)
• Co-Investigator(Kenkyū-buntansha): 森田 達也 聖隷クリストファー大学, 看護学研究科, 臨床教授 (70513000)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥3,380,000 (Direct Cost: ¥2,600,000、Indirect Cost: ¥780,000); Fiscal Year 2018: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2017: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2016: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
• Keywords: 多施設研究組織構築 / 死亡直前期 / 予後予測モデル / 患者登録完遂 / データ収集完了 / データ入力完了 / データ収集 / 倫理委員会承認 / 患者登録開始 / 医療・福祉 / 癌 / 臨床

Outline of Final Research Achievements

Accurate prediction of impending death is essential. We aimed to develop and validate a diagnostic model to predict death within 1 day in cancer patients whose Palliative Performance Scale (PPS) scores became</=20.
In this multicenter, prospective cohort study, we consecutively enrolled advanced cancer patients admitted to 23 palliative care units. We documented 15 clinical signs associated with impending death daily from the day when PPS declined to less than 20 to death or 14 days later. We used recursive partitioning analyses to develop a model with the entire dataset and conducted cross-validation.
1396 of 1896 patients (74%) became PPS</=20. The final model was based on 3 variables and 4 terminal leaves for 1-day mortality. The 1-day mortality rates among patients with urine output (u/o)</=200 mL/day and respiration with mandibular movement (RMM), u/o</=200 mL/day and no RMM, u/o>200 mL/day and RASS </=-2, and u/o>200 mL/day and RASS</=-1 were 69%, 32%, 15%, and 6%, respectively.

Academic Significance and Societal Importance of the Research Achievements

患者の人生の最期の瞬間（死亡直前期）を精確に予測する尺度を開発したことは、家族が病室に付き添うかどうか、遠方の家族を呼ぶかどうか等の重要な意思決定に役立てられる上で臨床的意義が高い。多施設の緩和ケア専門家が終末期患者登録を完遂する効果的な研究体制を構築しえたことは、国際的にも知見の少ない終末期ケア領域において、今後本邦で持続可能な大規模研究の開発を行っていく上で意義深い。

Research Products

• [Journal Article] Which physicians’ behaviors on death pronouncement affect family-perceived physician compassion? (2018)
  • Author(s): Mori M, Fujimori M, Hamano J, Naito AS, Morita T
  • Journal Title: J Pain Symptom Manage Volume: 55 Issue: 2 Pages: 189-197
  • DOI: 10.1016/j.jpainsymman.2017.08.029
  • Peer Reviewed
• [Journal Article] "What I Did for My Loved One Is More Important than Whether We Talked About Death": A Nationwide Survey of Bereaved Family Members. (2018)
  • Author(s): Mori M, Yoshida S, Shiozaki M, Baba M, Morita T, Aoyama M, Kizawa Y, Tsuneto S, Shima Y, Miyashita M
  • Journal Title: J Palliat Med Volume: 21 Issue: 3 Pages: 335-341
  • DOI: 10.1089/jpm.2017.0267
  • Peer Reviewed / Open Access
• [Journal Article] Communication about the impending death of patients with cancer to the family: a nationwide survey. (2018)
  • Author(s): Mori M, Morita T, Igarashi N, Shima Y, Miyashita M
  • Journal Title: BMJ Support Palliat Care Volume: 印刷中 Issue: 2 Pages: 221-228
  • DOI: 10.1136/bmjspcare-2017-001460
  • Peer Reviewed
• [Journal Article] Talking about death with terminally-ill cancer patients: What contributes to the regret of bereaved family members? (2017)
  • Author(s): Mori M, Yoshida S, Shiozaki M, Baba M, Morita T, Aoyama M, Kizawa Y, Tsuneto S, Shima Y, Miyashita M
  • Journal Title: J Pain Symptom Manage Volume: 54 Issue: 6 Pages: 853-860
  • DOI: 10.1016/j.jpainsymman.2017.02.021
  • Peer Reviewed / Open Access
• [Presentation] Diagnostic models for impending death in terminally-ill cancer patients who have become bedbound: A multicenter cohort study. (2020)
  • Author(s): Masanori Mori, MD, Takuhiro Yamaguchi, PhD, Isseki Maeda, MD, PhD, Yutaka Hatano, MD, Shih-Wei Chiu, PhD, Satoru Tsuneto, MD, PhD, David Hui, MD, MSc, Tatsuya Morita, MD, on behalf of the EASED collaborators.
  • Organizer: EAPC 11th World Research Congress
  • Int'l Joint Research