Deep sedation was necessary in 45% of those who received proportional sedation. Communication capacity was maintained in 34% with proportional sedation and 10% with deep sedation. IPOS decreased from 3.5 to 0.9 with proportional sedation, and 3.5 to 0.4 with deep sedation; RASS decreased from +0.3 to -2.6, and +0.4 to -4.2, respectively. Fatal events related to the treatment occurred in 2% (n=1) with proportional and none with deep sedation. Proportional sedation achieved satisfactory symptom relief while maintaining some patients' consciousness, and deep sedation achieved good symptom relief while the majority of patients lost consciousness.Proportional sedation achieved satisfactory symptom relief while maintaining some patients' consciousness, and deep sedation achieved good symptom relief while the majority of patients lost consciousness. The integration of palliative care into standard oncologic care has been shown to improve multiple outcomes in patients with advanced cancer. Ideal methods for integrating these disciplines is an ongoing area of discussion. One method of integration is a palliative oncology tumor board (POTB). To describe the implementation of a POTB in a community cancer center as a method of integrating oncology and palliative care by providing a forum for multidisciplinary discussion of complex cases. During development of the POTB, multiple influencing factors and barriers were considered including the setting of implementation, culture prior to implementation, design elements, engagement of stakeholders, and evaluation of implementation. The focus of this POTB was to address the identified communication gap between inpatient and outpatient care teams. Two complex hospitalized oncology patients were selected to be discussed weekly. Conferences were attended by an average of 23 individuals. The highest proportion of attendees were members of oncology support services (including nurse navigators, social workers, chaplains, dietitians, financial counselors; OSS; 31%), followed by medical oncology (25%). The most common theme of discussion was methods of communication with patient and/or family (68% of cases). Thirty days after presentation, a total of 50 new referrals were placed to inpatient palliative care, OSS, and outpatient palliative care and 11 new advance care plans were documented in the electronic medical record. This paper describes a sustainable method to implement a POTB in a community cancer center setting, which is one method of integrating palliative care into standard oncologic care.This paper describes a sustainable method to implement a POTB in a community cancer center setting, which is one method of integrating palliative care into standard oncologic care. Family functioning is a modifiable factor associated with major depressive disorder (MDD) and complicated grief (CG) among the bereaved families of patients with advanced cancer; however, the evidence regarding this association is limited. We aimed to explore the association of family functioning with possible MDD and CG among the bereaved families of patients with advanced cancer who died in palliative care units. This study is a part of the J-HOPE4 study, a nationwide cross-sectional multi-purpose questionnaire survey conducted in 2018. We recruited potential participants from 164 inpatient palliative care units in Japan and assessed family functioning with the Family Relations Index (FRI). Family functioning was classified into three categories (Well-functioning FRI ≥ 10, Intermediate FRI=8〜9, Dysfunctioning ≤ 7). The Patient Health Questionnaire 9 (PHQ-9) and the Brief Grief Questionnaire (BGQ) were used to assess depression (PHQ-9 score ≥ 10) and complicated grief (BGQ score ≥ 8), respectively. Mulre providers can identify risk factors for MDD among bereaved, dysfunctional family members. Code status (CS) orders lack a universal definition. We aimed to improve provider understanding of order options. Provider's knowledge of CS terminology, ease of understanding CS orders and ease of starting CS discussions. A multifaceted intervention including 1) altered CS order language in the electronic medical record (EMR) from "Full Interventions," "Limited Interventions," and "Comfort Measures Only" to "Full advanced cardiovascular life support (ACLS)," "Partial ACLS," and "No ACLS" 2) clinical tools for CS identification 3) provider education. Correct provider response rate for "Partial ACLS" and "No ACLS" terms increased from 43.5 to 60% and 20 to 71% (odds ratio 1.95; 95% confidence interval 0.99-3.83; P=0.03, OR 9.8; CI 4.48-21.49; P < 0.001). The proportion of providers who felt understanding CS orders and starting conversations about CS was "very easy" (a score of 1-3 on a scale of 1 to 10) improved from 26.1 to 45.7% (P=0.01) and 49.3 to 65.7% (P=0.03). Provider understanding of CS options can be improved with a combined QI intervention.Provider understanding of CS options can be improved with a combined QI intervention.Autonomy, which gives individuals the right to make informed decisions about their medical treatment, is a central principle in Western bioethics. However, we often encounter patients for whom a family member seems to dominate medical decision-making, to the extent that clinicians become concerned that the patient is subject to excessive pressure or even coercion. In this article, we describe one such case and how we assess a decision-making process that involves family influence. This entails acknowledging that many individuals weigh their family members' preferences and/or well-being heavily in making medical decisions, and family norms for decision-making differ. A family member who tells their loved one "You can't give up now" is typically not ursurping the patient's liberty to make a different decision. However, there are some family influences which may be autonomy-limiting, including credible threats, or in situations of abuse. Aside from these scenarios, our role is not to alter a couple's long-standing dynamics and decision-making processes. However, for the patient who wants to assert herself, we can set the stage in a family meeting and amplify her voice. this website We must also attend to the emotional level of family members' statements. "I won't let you give up" might be more a statement of grief rather than a true reflection of their values or intent. Supporting the family member's coping may help to bring together what initially seem to be divergent goals. Exploring these decision-making dynamics is key to providing good palliative care.