2019 years 10 May 28 days

General Incorporated Institute of Oncology Education Promotion Project
President Fukuoka Masahiro donoInstitution-workers： Yamato homecare clinic
nurse
Trainee Name Ayumi Tomizawa

2019 fiscal year according to the research grant
About submitting training reports

We will report on the title as follows.

Record

1 T r a i n i n g D i v i s i o n title MD Anderson Cancer Center Japanese Medical

Exchange Program JME Program 2019

2 training period

2019 years 8 May 22 thto 2019 years 9 May 27 days

2019 years 10 May 28 days

2019 fiscal Oncology Education Promotion Project

Training Report tell Statement

Training Division title

MD Anderson Cancer Center Japanese Medical Exchange
ProgramJME Program 2019

Affiliated organization / professional

medical corporation Yamato

Yamato homecare clinic

nurse

Training 's name Ayumi Tomizawa

Mission and Vision created through training● Mission:

Improving the quality of cancer symptom management for patients and theirfamilies by providing teleclinic ease of clinical access for cancer patients at home

● Vision:Improve self-care ability to reduce the fear and anxiety of cancer patients.

Ⅰ Purpose / Method. the purpose
1) MDAnderson Cancer Center team medical body with respect to cancer patients(Multidisciplinary Cancer Care Approach) In fact the Showing academic through and staff
communication beauty, learn the approach to home care team construction of cancer
patients in the region2) Learn the actual decision support for cancer patients and their families to become thecenter of cancer team medical care3) Team Building and Career the develop instruments in, won a variety of management
ability, to create its own mission, vision
2. Method<Contents>
1) MDACC in each department that has been the practice of the team medical fact of thevisit , conference participation
2 ) Lectures and discussions on career development, leadership and team building3) Lecture on ethics in medical care , visit to ethics conference4 ) doctor, pharmacist, the mission and vision in the team of nurses to build , oncology
project of creating and making a presentation.
<< Participants >> 2 doctors, 2 pharmacists, 2 nurses

Ⅱ Content and progress
1 backgroundThe country is making various medical reforms in preparation for the 2025 super-agedsociety. One is the enhancement of community medicine and the promotion of homecare. Many cancer patients are still in hospitals at the end of treatment, eventually resulting
in disuse syndrome and increasing unnecessary medical expenses. The hospital iscoordinating the increase in discharge nurses and social workers for earlydischarge. However, there is a sense of burden and anxiety about home care for patients andtheir families, and the promotion of home care has not progressed much. Why isthat? Large kina There are two reasons think that. The first is that the resources and qualityof home care are not improved, and the second is that the education of the patient family is
not sufficient.
Then, through the time of the training, in order to solve the two problems, theirown Mission was to create a vision.
2. Multidisciplinary team approach at Outpatient
1) Outpatient Brest
Outside coming team, has a different team for each doctor. The main members are one
doctor, NP, RN, and pharmacist scheduler. Members of roles is clear,
the Scheduler is the patient's arrival the check, nurses are the state confirmation oforganizing information and other patient of new patients. New at the time of thevisit patients are triple-negative inflammatory breast cancer was a patient of. Nursing inafter you share information with protection nurses and medicine and doctors, performs ashort meeting at the physician's Brest team, the examination room medical staff to move
to. This mechanism is very different from Japan. RN performs the first interview andorganizing information, patient 's medical examination and a change of clothes so thatexamination is immediately possible room waiting in the are. The following contacts will
share detailed information after conducting a detailed physical assessment at NP andconfirming their progress. Then, the main jig physician (Medical Oncology), surgeon ,radiation therapy physicians , including NP , all the team staff, such as a research nursealigned to the examination room, jigs towards the decision-making about the contents of thecare had been witnessed in the description of . All members of the team will confirm theinspection, and the direction of the treatment policy will be confirmed by theentire team. When a patient asks what the case for surgery is, the surgeon answers on the
spot and the patient does not wait for a long time to visit each department like Japan. The
explanation is 1) Treatment options (what types are available) 2) About surgery 3) Aboutchemotherapy 4) About radiation therapy 5) About clinical trial All treatment time, side
effects, effects, etc. are explained many are from the previous physician, MDA trials havebeen conducted in the case multi undergoing description of yet. The patientis visiting MDA for any effective treatment. After the treatment of the decision is, themain jig doctor again, sign a consent form to fill out the note while confirming the decision
to go to medical examination (electronic signature). In the explanation, the SPIKS setting isfirmly implemented and it is not a one-sided explanation, but it is solved on the spot so that

there are no concerns such as skin ship, consent, consideration for family, dealing with
anxiety, questions from patients, etc. It was. After that, the clinical trial
coordinator explained the flow of treatment. I felt that it was important not only to shareroles as a team oncology, but also to share information with the team at the same time, sothat the patient's reception of words was not different due to differences in perspectives orvalues. For patients, anxiety is quite high because it takes time to reach a specialist. It is not
only commitment to the examination style, but also how you can go to the examination in a
comfortable environment. Because of being a female outpatient, privacy considerations andvoices were also fully implemented .
At the Brest Survivor Clinic, patients will be followed up, focusing on hormonal therapy 510 years after surgery. Usually, doctors are not resident, and NP is following up. NP also
handles all examinations, regular inspections and prescriptions. When there is a change, it isstructured to receive medical attention from the doctor in charge. The patient had little
waiting time, the patient was relaxed, and the outpatients had many smiles such as family
stories and travel stories.
2) GVHD clinic
Have undergone a stem cell transplant. Graft-versus-host disease (GVHD) is a complicationthat can be fatal. Because GVHD damages multiple organ systems, its treatment may
require the collaboration of dermatologists, ophthalmologists, respiratory physicians, andother specialists. The clinic consists of GVHD specialists anddermatologists, APRN, (treatment and patient guidance) RNs, and pharmacists. Skin
symptoms of GVHD are prominent, and early detection andtreatment prevent the development of secondary cancer. I felt it was important for thedermatologist to be on the team. In MD Anderson and almost all stem cell transplant
centers in the United States, patients are monitored closely by the transplant team until
about 100 days after transplant until the engraftment is clearly confirmed by recovery ofblood counts after stem cell transplant. Make sure that the immune system has recovered,does not develop an infection, and most importantly, has not developed GVHD. Patients
who have undergone a stem cell transplant will be handed over to their local physician
approximately 100 days later. MD Anderson's transplant team works closely with local
physicians. The Stem Cell Transplant Survivorship Clinic provides all the informationneeded by local physicians, who have information about tools that can help with chronic
GVHD screening and what to do if GVHD is suspected. Physicians watched the patient's
guidance to return to the community 100 days after the visit, where any questions orconcerns could be contacted at any time by survivorship clinic medical staff. He gave
detailed guidance on all the contents related to the patient's daily life. From infection
control to early detection and treatment of abnormalities, sufficient guidance was given not
only to patients but also to families using data. Patients and families were taken care of sothat they could return home and acquire self-care skills.
3 ) Outpatient GI
In the outpatient department of digestive surgery, the team was organized differently. It
consisted of doctors, RN, PA and dietitians. The pharmacist was in a separate room but at aplace where he could consult immediately. Many patients return home with drains in place
before and after surgery. An elderly patient went to the hospital using a walker, but thepatient was able to self-manage his / her medicine and drain management. The involvementof a dietitian is important because patients with gastrointestinal cancer often havesignificantly reduced nutritional status. Order on nutrition are also carried out, such asdetailed nutrition assessment and weight management nutritionist has notdone that. Here, PA (physician Assistant) was conducting physical assessments andinterviews.
At each outpatient clinic, a characteristic oncology team was established,
and I felt that patient education was provided so that cancer patients could spend time athome without anxiety.
4) Ambulatory Treatment Center
MDA has five outpatient chemotherapy rooms. As many as 400 treatments a day. This time,
we performed shadowing of RN and observed the actual treatment. The treatment center
takes care of an average of 10 nurses a day between 7:30 and 22:30. At the same time, I will
be in charge of 3-4 rooms and will be in charge of the treatment of the next patient as soon
as each room is finished. In Japan as well, because there are many treatment patients, bed
adjustment seemed to be very difficult. The leader adjusts the bed, and when the bed isavailable, the assistant cleans up and makes the bed. There was a system for safe treatment
in such a fast turn. Of course, mixing of anticancer drugs is performed by technicians at thedispensing center. The drug carried to the treatment room was sent to the patient byelectronic authentication and double check, and the check system was the same as that of
the chemotherapy center that I was doing by starting the drug double check with thepatient. The patient's treatment rooms are all private rooms and were as large and equipped
as hospitalized rooms. Because it was a private room, I felt that there was a loss of time insearching for other members during the flow line and double check. Although it is importantto consider safety in all cases, I felt that introduction of pairing could be effective inconsideration of patient waiting time. There seemed to be an RN dilemma in hard
work. However, the relationship of trust with patients is deep, and some patients havecontinued treatment for several years. Care and voicing to the patient who attended thetreatment scene that had overcome difficulties many times was very polite.
3. Inpatient Multidisciplinary team approach
As for the hospital ward, we visited the stem cell transplant ward. MD Anderson's Stem Cell
Transplant and Cell Therapy Center is said to be one of the world's largest facilities for stem celltransplant. There are many patients who are very severe and difficult to progress, and further
teamwork is required. In this tour, we were able to see the flow of patients after
transplantation, although they were separate patients on the day of transplantation, day 2,
and before discharge. Again, N P, had the role of the RN, pharmacist, technician, enoughtime to share information with many co-medical and physicians such as rehabilitation
stuff. Many patients are waiting, and bed control and discharge adjustment are often very
difficult. In addition, infection control needs to be performed under stricter control thanother wards. The examination data after transplantation and the symptoms of fever may also
require a sudden restart of the gown technique, which is also displayed in door signs andmedical records, and consideration is given to notifying each staff member. Even if you aredischarged from the ward here, you will be asked to wait by renting a residence near thehospital. Discharge guidance was given not only by nurses such as NP and RN, but also by
pharmacists, but the main content was infection management, including infection control.
4). Discharge support at MDA
MD A hospital bed running number in 2018 is 587. In contrast, the total number ofhospitalized patients is 29,118 people per year. The average length of stay calculated fromthis is about 5 days. The average length of hospital stay in Japan is about 12 days, and thedifference in the current situation is clear. Previously he also circumstances that had carriedout the discharge adjustment and bed configuration roll, low areas of the resources may also
be that affected the length of stay, a giant of M DA purpose of to learn the actual for thedischarge adjustment in It was one. This time, with the consideration of mentors, I was able
to contact the case manager of the blood transplant ward and MSW, and I wasable to learn in detail the relationships of each occupation regarding discharge
adjustment. The flow, NP is carried out in the center of the symptom management, confirm
the hope of leaving hospital to patients and their families, we are considering a team for thedischarge order and direction in the previous round. There are also significant differences inthe state of anxiety and where the hospital is discharged. If consent to discharge is obtained

at the round visit, patient guidance from CNL and adjustment of discharge destination fromcase manager. Furthermore, multi-disciplinary teams are collaborating not only in hospitals
but also outside hospitals through satellite construction and group clinics. The case manager
has a nurse license. There are three case managers on one floor. The hardest part is where
you go depending on what the insurance cover can do. Some people go home while
continuing treatment, but there are many nursing homes and hospice hospitalwards. Hospice selects and introduces patients who need pain management and symptom
management. The referral method introduces nursing home information directly to thepatient's and family's e-mails in about three places and sends an e-mail with a letter of
introduction attached to the attached material. In advance, consideration is given to thereferral destination, such as sending a date when a family member or patient visits byfax. The letter of introduction included detailed data on the condition of the day(the necessary information for the blood ward was sent as much as possible), as wellas information on immunization and the type of insurance. In addition to the history oftreatment so far, the history and contents of entering ICU are added, there is a template forproviding detailed information, and there is a medical record system that makes it very
easy to create a summary. (If a record is selected and pasted, it will be created according to
the template.) There is no need for confirmation from a doctor, and it is interacting with theoutside. Blood cancer patients often require blood transfusions,
I also blood transfusion at home that. However, there is a considerable amount of training
and training, and a facility that does not clear it is not possible. At-home clinics are systems
similar to those in Japan, such as doctors and nurses, PTs, OTs , and nursing care. Main to
the NP in cooperation with the often RN that has managed and carried out home-visit
nursing care. There are enough local resources to select a home care clinic or visiting
nursing station near the patient's home from a site such as Medicare . The local resources
have been evaluated, and information is provided to patients by selecting areas with highevaluation. Unlike Japan, the patient, financial problems from there is a sudden discharge
hope because they often wish to hospital as soon as possible. On weekends, there may be 10
or more information preparations a day. It is shared by three care managers, but tocooperate each perform. In cases where it is difficult to adjust the discharge, it is often
readjusted due to problems such as the inability to continue treatment at the transfer
destination and insurance coverage, even if there is an initial hope. In hematology several
people, more than half a year case that is also in the hospital is located. Difficulty incontinuing treatment or controlling symptoms. The discharge destination is narrowedby the difficulty of the recipient and the extent of insurance coverage. Like Japan, insurance
is not guaranteed in the country, which is a major medical problem.

Although MSW has a wide range of roles, we confirmed how it relates to the discharge
coordination team. MSW has always worked with the medical team to select information
sharing by e-mail or telephone depending on the urgency of the problem. MDA most of andaround EPIC due to the use of electronic medical records by the most of the clinics, groupmailing list of some form there is, Texas is located in a large organization called the Medical
Center of TMC . MSW may coordinate hospital admissions. In order to deal with thephysical symptoms or problems emergency requiring hospitalization in some cases. Some ofthe emergency hospitalizations are due to patients or families having unrealistic
expectations about their illness, or poor understanding of diagnosis, treatment goals, andprognosis. Further clarification of the DNR could there be a barrier had said Ru . In
addition, Ethics Consultation Service Patient Advocacy , Patient Advocacy , Psychiatricservices , Social Work , Spiritual Support , Supportive Care Center
Case Manager in comparison with the lack of understanding of what to do social workis there is it is sometimes feel somewhat difficult.
5). Palliative care situation
Lecture and visit about Houston Hospice (Inpatient Hospice).
1) Palliative care ward
Visited care through RN shadowing. Take care of 3 patients a day. Symptoms observed
item detailed symptoms other than pain to have evaluation criteria with, NCCN has evaluation
criteria will be created on the basis of the guidelines. RN inputs symptom observation according
to the evaluation table. Although NP may evaluate in advance, it is conducted twice a day. Pain
assessment uses NRS. The standard for judging pain management is poor is consulting with NP
and doctor when using 3 boluses with 1 shift . Palliative care wards involve more
multidisciplinary types than other wards. PT, OT, physical therapist and WOC round once aday. The palliative care ward is different from the Japanese image, and patients undergoingtreatment are hospitalized. Occasionally, chemotherapy patients are hospitalized for bed
control. There was a lot of staff coming and going to deal with all departments, and I had a busy
impression. There are about 20 palliative care NPs and PAs in the ward. NP can also ordernarcotics. There are many checking mechanisms when prescribing and there are fiveconfirmations. The NP conducts an assessment round before the team rounds to assess
symptoms. Information is then shared at the meeting and a team round is held. The base of pain
control often uses hydromorphone. Popular in Japan, oxycodone is expensive and not a first
choice. The opioid overdose is becoming a problem and is said to be in compliance with
the WHO rudder, starting with analgesics and combinations. The discharge destination is home,
hospice. We observed the discharge assessment of patients who were discharged on the same day

in the palliative care unit. ADL, I In addition to ADL, there were skin problems and pressure
ulcers, but the skin condition was checked by two nurses. There is a thorough assessment of
whether there is a hindrance to life after discharge and the need for services. I felt that I wasaware of responsible care.
2) Huston Hospice
Houston Hospice is Houston 1 be the first hospice in 980 founded in the year. This time it was
only a hospitalized hospice tour, but there is also a home team that cares about 130
patients. Because it is possible to link home and hospitalization, respite for temporary
hospitalization for symptom relief and family burden reduction
We accept hospitalization. The main point of introduction is MDA, but it is accepted from allover Texas. Medicare and Medicaid covers are available. Houston hospice, Texas Medical
Center , Texas non-profit hospice Alliance , Texas New Mexico Hospicemechanism member is.
Hospice Interdisciplinary Team is N Using Staff, Social Worker, Chaplain, Dr, Volunteer,
Bereavement Coordinator is configured with. While involved each as a professional, not tosupport the patient, the family from the perspective of many fields that. Here we accept not
only cancer, but also patients with all diseases that have been informed about their life
expectancy for half a year. While acceptance dementia patients in the same way, perceiving
the patient of 1,200 people a year are interest. Treatment may also be continued, there isalso sometimes emergency hospitalization, acceptance from the ICU has a. In addition, as afeature of this hospice, family care, grief care is also a variety of services are
deployed. volunteer also has more than 100 people registered, shopping assistance and hairstyling, there is also the appearance care, such as a nail, it is one of such an environment
spend at home furnished are. In addition, there is also a 24-hour on-call service, anxiety
correspondingly have to family features. The church also 2 is open 4 hours, environment
near that you can enter and leave at any time. Outside the window, there was a nice garden
and fountain, and it was possible to take a walk with the pets brought by the family.
6). Ethics consultation and ethics meeting
Dr .Theriault through lectures and discussion about the ethics adjustment from , such as insituations such as treatment selection and treatment of the end, the patient, family, when there isa conflict in the value of the medical staff, medical staff is patient only question, to family Often
throws. MDA has a 24-hour ethics consultation desk. In addition, the Advocate Center and MSW
contact points are also available as consultation points away from medical professionals. Patientsand families are often confused by many questions and fall into a psychological situation where itis difficult to make the right choice. In such a case, an approach that draws out the patient's life

background and values and draws out the patient's own appearance rather than pressing medical
choices is important. In communication, the medical professional spends a little more time forcommunication and cannot bring out the patient's true intentions without his spare time. In
addition, correct judgment cannot be made while symptom management is not possible. An
ethical point of view must always have a broad perspective and show an attitude that patients andtheir families just want to speak slowly so that they can speak in their own words.
Also, the ethics conference held in the ward by Dr. Joyce is very important. Nurses often have adilemma in the hopes and values of doctors, patients, and families. Meetings within the sameteam are often involved in value conflicts. By receiving consultation from outside the team, you
can get a bird's-eye view of the phenomenon. In this case, they were able to freely discuss theirthoughts and opinions regarding the choice of treatment place .
7．Nursing education ( mid-level-career)
M DA, the 3700 or more people of nurses is a member. Of these, 400
have APRN qualifications. APRN (Advanced Practice Nurse) is classified as follows.
1) Anesthesia nurse (CRNA) : Anesthesia is provided to patients of various ages and care isprovided to the anesthetized patients. The area of activity includes all scenes in whichanesthesia is performed on patients, and the place of activity varies from hospital surgery
and operating rooms, obstetrics, acute care, pain management, surgical outpatients,
dentistry, foot pain treatment, ophthalmology, plastic surgery, etc. It is.
2) Midwife (CNN) : Provides a lifetime health care service for women. Its activity areas
include homes, hospitals, maternity hospitals, various outpatients, company medical offices,and public health.
3)Clinical Nurse Specialist (CN S ): it plays a unique role that is taken as a whole thecontinuum of patient-nurse system to integrate care. Conduct cross-organizational activities
such as care improvement, RN education, quality improvement, practice promotion,
problem solving, expert consultation, individual patient care, care development, researchand publication.
4) Nurse Practitioner (NP): Provides patients with primary care and care for acute diseases
and injuries. In addition to examination, diagnosis and treatment, he has the authority to
manage chronic diseases and order tests. The center of the activity is direct patient care, andhealth promotion, disease prevention, health education and counseling are also importantroles.
Other than the above, there is a qualification as a clinical nurse leader. In this training,
we observed CNL activities. CNL functions as a leader in the clinical environment, practiceand quality improvement are focused on. Their cancer nursing nurse specialist (OCN) has
been working as, became in charge of CNL is O CN has a qualified, five years ago CNL also
received qualification. He stated that the role of CNL is similar to OCN. CNL serves asa generalist as a multidisciplinary team. For nursing education, Professional Practice
Model on the basis of, practice based on research and evidence areraised. Providing professional value and patient care and encouraging active participationin research. Nurses recognize that EBP and study participation are core requirements forclinical progress programs. EBP (Evidence Based Practice) The EBP, by practicing capture
the latest evidence to care, an activity that aims to provide the best care is . The EBP team isformed in a department that provides nursing at the forefront and is working toward thepractice of care from a professional perspective.
8．Patient education
Patients have the opportunity to study at any time through many free brochures and libraryrooms. In particular, there is a coordinator in the library so that you can learn about thedetails of the trial. Even online, patient classrooms have various environments such as
nutrition, exercise, and survivorship care programs. The patient's own management is given
guidance when diagnosed to do it himself. Because of early discharge such as drug
management and meal management, patients acquire various medical knowledge bythemselves. Many Japanese cancer patients still hear the phrase “I will leave it to theDr.”. The doctor also says, "Let me entrust", but only you can know the intensity of yourown pain. Adding knowledge to the patient may result in more questions and questions, andthe medical staff may spend extra time. However, if the self-care management ability isimproved as a result, the number of emergency outpatients will decrease, and unnecessary
time will not be required without causing a sudden change in medical condition. Medicalcare is not only for medical professionals, but it must be educated from how it is necessary
to face and know about your illness . And is not in a world where unfazed yet been said to bedisease called "cancer", to reduce the fear of that "know" by those of the media andcelebrities to confess the "cancer", leave "your I felt that it was important to gradually
educate Japanese cancer patients in “medical care” in the region. MDA is No. I feel that
one of the reasons for includes “high patient power”. Outpatients were always smiling andsometimes they greeted us with care and did not know which was the patient. I felt that theprovision of a learning environment was linked to the high level of patient power.
9. Leadership and Difficult conversation
1) Difficult Conversation

The important thing in team building is how to manage many conflicts to achieve the team's
mission and vision. In this lecture, we had the opportunity to learn how to negotiate andproceed with conversations in difficult situations. In many situations, it was often better tostay silent and avoid as much as possible. But in the lecture, learning to
confront and navigate is a valuable skill that will help you succeed. First important thingis, with a compassion that. Taking the compassion and communication, word is easier tohear, which is likely a positive impact on the results you want that. Next, be honest, there isa danger of losing credibility in the eyes of the people you are trying to communicate,possibility there that does not reach the result that really satisfactory Ru. There are many
inconsistencies in content and understanding that are difficult in the medical field. It is also
necessary to replace the “Sugar–coating” technology with words that are easy touse. Finally Active listening is one of the most powerful communication tool there. Bylistening, valuable information is obtained to facilitate the communication of mutual
resolution Ru. I was able to learn that listening to the question of knowing the differences invalues and culture and knowing the other party is an important technology to fill thegap. " Speak U the p- " obediently to interpret that question or not can be. In an area where
there is a culture of silence as a virtue, I felt that it was necessary to continue training in the
future on how to raise questions and support the hope of patients and families.
10. Carrier Development
Dr. Ueno, conscious about the career, their mission, vision is how in the world whether
there is an impact, thought Where is their uniqueness. First, " Individual Development
Plans " for learning how to perceive and learning to appeal
Built. Up until now, I was planning to build a career with my own strengths, but I wasn't
aware of " Impact to Play, Winning to Play" for society. I felt anew that the image ofsomehow wanting to do this would not reduce my motivation and continue. I felt that it was
important to be aware of where and what to make use of the network, taking advantage ofthe strengths of my organization. And we want to comply with the mission and vision we
have decided, but not conflict with the organization. In Japan's medical field, hierarchies arestrong, and it is difficult to give opinions to your boss. However, I felt that “not to say” isthe same as “I don't think. I have no opinion” and that it is important to have a technologythat allows you to experience and navigate difficult conversations. I was able to learn about
the relationship between mentor-mentees. Menta-Was considered as a leader and mentee was taught in a hierarchical relationship, butlearned that "Mentee nurtures mentors", and always shared the mission and vision,and consciously involved to grow each other. I felt it was an opportunity to encourage. I wasable to learn once again how important the word “spoken execution” in the organization is.

Ⅲ Results
Based on the results of the above training, regarding the oncology program created by thegroup,
Team B (Team Name Team Best) Rurina Watanuki Ayaka Kashimura Ayumi Tomizawa➢Mission
To improve patient’s satisfaction in oncology outpatient clinic through multidisciplinary
collaboration➢Vision
To optimize medical care for cancer patients to improve their self-care management skills
and make them actively participate in their treatment by offering information and educationfrom multidisciplinary teamFirst of all, we newly form the multidisciplinary team for outpatient. We know each otherwhat different disciplines do and what they are good at. We can build a trusted relationshipand we can effectively collaborate for patient care or research. Using each expertise andexperience, we will provide a good education and will have enough time to communicate
with each patient.
Patients’ knowledge and self-care management are fully expected to improve. We would
like to make the patients actively participate in their treatment.
It causes that they feel relieved, get successful treatment, get good symptom management
skill. Finally, we have no doubt that patient satisfaction greatly improves.
Medical care; Goal: to effectively take advantage of the experience and expertise of eachfield, to provide the best of care to outpatient that, as planned, pharmacists participate in
the foreign team to, multidisciplinary team to determine the treatment policy in
Do. Delegate some work to other disciplines.
Education: The goal: all health care providers, to provide the best clinical practice, acquirecommunication skills in order to constantly improve the skill to . Provide educational
programs to improve patient self-care management skills. Planning: for the care provider
communication skills training program and education program for the patient to use thewaiting time effectively the development of.
Study: Goal: Clarify that multidisciplinary care intervention improves patient satisfaction

Plan: Prospective intervention study
Ⅳ Future tasks
Based on the learning gained here, we will build an education system for all occupations
that care for cancer patients at home in the community. The plan for the implementationof telemedicine and education for improving self- management ability of patients, which areincluded in the mission, is underway for implementation during the next fiscal year.
As for staff education, in addition to in-hospital training, lectures for graduate schools andspecialized nurses are being planned. In addition, J-TOP strengthen cooperation withmembers of, we want to work towards the holding of oncology team care program in the
Tohoku region. We would like to increase the number of home clinics, which is our goal,and provide high-quality treatment facilities at homes where cancer patients wish.
Team building, your leadership information, is a core value, connection, information heat
I want to be active listening for difficult relationships without forgetting compassion andthreatening value. In the future, it will be necessary to paradigm shift not only the homefield but also the medical systems established so far in the age of high growth. At-homesupport for cancer patients requires awareness reform not only for the patient's family but
also for the medical professional. In response to the national policy of moving the Japanese
strategy worth hospitalization to the home, we will take action and endeavor to achieve ourgoals using our expertise and positioning as home care. To that end, I would like to improve
the quality of home medical care and improve reliability.

Ⅳ Acknowledgments
Thank you very much for this wonderful opportunity. I want to thank you very much for Prof.
Ueno, Joyce, and Theresa and Nick for coordinating the program.
I also really appreciate the kindness of all the US mentors and Families.
I would also like to thank Mr. Fueki and Marcy for their support.
I want to thank Dr.Yuya Sasaki, Dr.Iwase, and his family members.
I want to thank the members of JME2019 who spent the last five weeks laughing, crying, andtalking a lot. I'm thankful to you.
We will continue to work hard to change Japanese medical care.