End-of-life cancer care quality in rural areas of Japan: an exploratory bereaved family survey.

INTRODUCTION

Palliative care is essential for people with life-threatening illness, yet access remains inequitable in many rural areas. In Japan, rural disparities in end-of-life (EOL) cancer care have not been well described. This study examined rural-non-rural differences in EOL cancer care quality in Japan.

METHODS

This study was a secondary analysis of a nationwide cross-sectional questionnaire survey of bereaved family members of adults who died from cancer in Japan in 2021. Rurality was defined using the Rurality Index for Japan, with rural areas defined as RIJ ≥ 75. Quality of EOL care was assessed using the Care Evaluation Scale and achievement of a good death using the Good Death Inventory. Weighted proportions were compared between rural and non-rural areas, and weighted multivariable logistic regression models adjusted for age, sex, and cancer type were fitted.

RESULTS

A total of 1226 responses were received (response rate 54.0%). Among decedents, 8.7% resided in rural areas. Across Care Evaluation Scale items, rural areas generally showed lower proportions, with the largest difference in multidisciplinary care coordination (78.3% vs. 87.7%, weighted), which was significantly lower after adjustment (OR 0.43, 95% CI 0.22 to 0.85). Rural areas also showed lower proportions across Good Death Inventory items, including being free from physical distress (29.8% vs. 42.3%, weighted).

CONCLUSIONS

Quality of EOL care and achievement of a good death were lower in rural areas of Japan. Care coordination may be an important target for improving rural palliative care.