Current situation and support need for non-cancer patients' admission to inpatient hospices/palliative care units in Japan: a nationwide multicenter survey

Background: Specialist palliative care for non-cancer patients is important; however, access to inpatient hospices/palliative care units (PCUs) for non-cancer patients in Japan may be insufficient. We aimed to explore the current situation, the support needs to accept admission of non-cancer patients, and the willingness to accept admission of non-cancer patients to inpatient hospices/PCUs in Japan.Methods: We conducted a nationwide multicenter anonymous questionnaire survey to inpatient hospices/ PCUs in Japan in January 2022. We recruited potential participants from 381 PCUs belonging to Hospice Palliative Care Japan (HPCJ).Results: A total of 264 of 381 facilities responded to the survey (response rate: 69.3%) and 75.0% replied that it was "very necessary" or "necessary" to provide health care coverage of hospitalization costs of non cancer patients to the same level as cancer patients in inpatient hospices/PCUs. Furthermore, 59.1% replied that they would be "willing" or "somewhat willing" to admit non-cancer patients under the assumption that hospitalization costs covered by health care insurance. In addition, 15.2% of facilities had admitted non cancer patients. A need for clarification of admission criteria for chronic heart failure (CHF) (rs =-0.166, P=0.008), chronic respiratory failure (rs =-0.146, P=0.019), chronic hepatic failure (rs =-0.161, P=0.010), and chronic renal failure (CRF) with dialysis (rs =-0.151, P=0.017); the need for an education and training system for chronic respiratory failure (rs =-0.132, P=0.034); and advice from experts in the hospital for chronic respiratory failure (rs =-0.156, P=0.013) were significantly negatively associated with willingness to accept the admission of non-cancer patients. Conclusions: A total of 15.2% of facilities had admitted non-cancer patients under the current situation, and 59.1% of the facilities were willing to accept the admission of non-cancer patients under the assumption that hospitalization costs would be covered by health care insurance to the same level as cancer patients. Our study highlighted the importance of the establishment of a health insurance system in which appropriate palliative care is available regardless of disease, the definition of admission criteria, and the establishment of a systematic educational program.