Nursing Practice for Patients with Cancer Pain with Predicted Prognosis of Months or Weeks: A Multicenter Cross-Sectional Study in Japan

Student summary

Why This Research Matters

Cancer pain does not always need a pill or an injection to be eased. Nurses working in palliative care units (PCUs) also use nonpharmacological, hands-on comfort measures — things like adjusting a patient's position, keeping the room calm, or offering mouth care — alongside medication. Until now, though, nobody had a clear national picture of how often Japanese PCU nurses actually use these approaches, or whether that changes as a patient's expected survival time shortens from months to weeks. This study, published in Palliative Medicine Reports in 2025 by Morikawa, Kobayashi, Kajiwara, Nakano, Kanno, Matsuda, and Kako, set out to answer that question.

The researchers ran a nationwide online survey of registered nurses working in Japanese PCUs. They contacted all 389 PCUs operating in Japan and asked them to take part; 162 units agreed. Individual nurses at those units were then invited to respond anonymously, and 539 of the 2,448 nurses invited completed the survey — a response rate of 22.3%. Nurses were asked how often they carried out each of 23 defined nursing support items for cancer pain, separately for patients whose prognosis was estimated in months and for those whose prognosis was estimated in weeks. Rather than running statistical significance tests, the team reported descriptive statistics — essentially, how common each practice was, expressed as a percentage of nurses using it frequently.

The headline finding was that the pattern of care barely changed between the "months" group and the "weeks" group: nurses used roughly the same mix of supports regardless of how close to end of life the patient was thought to be. What did vary a lot was which types of support were common at all. About 80% of nurses said they frequently provided what the study calls "comfort care" — adjusting the room environment, offering emotional/mental health support, and doing oral care — plus repositioning the patient to ease pain. These are relatively simple, low-tech measures that most bedside nurses can do without extra equipment or specialized training.

On the other end of the spectrum, a long list of more specialized nonpharmacological therapies were used frequently by fewer than 20% of nurses. These included progressive muscle relaxation, guided imagery, combined relaxation techniques, cognitive behavioral interventions, reflexology, self-administered acupressure, therapeutic exercise, poetry appreciation, auricular acupressure, virtual-reality-based relaxation, and reiki. In other words, the techniques that usually require dedicated training, certification, or specialized equipment were rarely used, even though there is a body of evidence supporting some of them for pain and distress.

The authors concluded that basic comfort care and positioning are the backbone of everyday nonpharmacological pain support in Japanese PCUs, while more specialized techniques remain underused. They frame this as an opportunity: expanding nurses' access to training, time, and resources for these underused therapies could broaden the toolkit available for patients with cancer pain near the end of life.

For a nursing student, the practical takeaway is twofold. First, comfort measures that feel almost too simple — repositioning a patient, adjusting lighting or noise, doing mouth care, sitting with someone who is anxious — are exactly the kind of evidence-informed, low-barrier interventions that frontline nurses rely on constantly, and they deserve to be taken seriously as clinical skill, not just "basic care." Second, the gap between what is recommended in palliative care literature and what is actually implemented at the bedside is real and worth questioning: if a technique like guided imagery or reflexology is rarely used, is that because it doesn't work, because nurses lack training, because units lack time or staff, or because there's no clear protocol for offering it? This study cannot tell us which explanation is correct — it only tells us the practice gap exists. As with any single cross-sectional survey from one country, be cautious about assuming these percentages would look the same in a Canadian or other international PCU, and remember that self-reported frequency of care is not the same as verified clinical practice.

Faculty notes

Educational Relevance

This 2025 Palliative Medicine Reports article by Morikawa, Kobayashi, Kajiwara, Nakano, Kanno, Matsuda, and Kako reports a nationwide, multicenter cross-sectional survey describing how often Japanese palliative care unit (PCU) nurses implement 23 defined nonpharmacological nursing support items for cancer pain, and whether implementation frequency differs by patient prognosis category (months vs. weeks). The team invited all 389 PCUs operating nationally; 162 facilities agreed to participate, and nurses at those units were invited anonymously online, yielding 539 respondents from 2,448 invited nurses (22.3% individual response rate). No inferential statistical testing was performed; findings are reported as descriptive implementation frequencies, which is an appropriate and transparent choice given the study's exploratory, mapping purpose but limits any claim of a statistically meaningful difference between the two prognosis groups.

The central finding for classroom discussion is the near-identical implementation pattern across the two prognosis strata — nurses did not appear to meaningfully change their nonpharmacological pain-support repertoire as patients moved from a months-scale to a weeks-scale prognosis. A clear implementation hierarchy also emerged: general comfort measures (environmental adjustment, mental/emotional support, oral care) and positioning/posture adjustment were frequently used by roughly 80% of respondents, while an extensive set of more specialized nonpharmacological therapies — progressive muscle relaxation, guided imagery, combined therapy, cognitive-behavioral intervention, reflexology, self-administered acupressure, exercise, poetry appreciation, auricular acupressure, virtual-reality relaxation, and reiki — were frequently used by fewer than 20% of nurses each.

For appraisal purposes, this is a hypothesis-generating descriptive survey, not an intervention or outcomes study: it tells us what nurses report doing, not whether any given practice improves pain control, and it cannot establish why specialized therapies are underused (training gaps, time/staffing constraints, lack of institutional protocols, or absence of perceived efficacy are all plausible and indistinguishable here). The 22.3% individual response rate and 41.6% facility participation rate (162/389) raise nonresponse bias concerns — nurses more interested in or confident about nonpharmacological pain care may have been more likely to respond. All data are self-reported frequency estimates rather than observed practice, and the sample is drawn exclusively from Japanese PCUs, which limits direct generalizability to Canadian or other international palliative settings given differences in staffing models, scope of practice, and training infrastructure for complementary therapies.

Methodologically, this paper belongs to a coordinated research program by the same author group examining nonpharmacological nursing support across several cancer symptoms (pain, nausea/vomiting, dyspnea, delirium) using the same national PCU sampling frame; a companion nausea/vomiting paper from the same project, drawing on the identical 389-PCU/162-participating, 2,448-invited/539-responding sampling frame (used here only as supplementary methodological context, not as evidence for this paper's own results), reports the survey was conducted online from October 2023 to March 2024 using a five-point Likert implementation-frequency scale. Instructors can use this article to teach critical appraisal of descriptive cross-sectional surveys: discuss why no statistical testing was used, what response-rate transparency adds to trustworthiness, and how a practice-frequency gap (common comfort care vs. rare specialized therapy) should inform — but not dictate — curriculum and continuing-education priorities in palliative and oncology nursing.