{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:52:33Z","timestamp":1781632353272,"version":"3.54.5"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"The Ministry of Health, Labor and Welfare Research for Promotion of Cancer Control Program","award":["23EA1023"],"award-info":[{"award-number":["23EA1023"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Palliat Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The use of patient-reported outcomes (PROs) can facilitate the reduction of the severity of patient symptoms. Several countries have implemented projects that routinely use PROs in palliative care settings, resulting in increased patient symptom improvement rates. In Japan, a pilot study of hospital-based palliative care teams was conducted in 2021; however, no study has been conducted in palliative care units (PCUs). This study assessed patient symptom improvement rates using PROs and evaluated the feasibility of routine PRO assessment and data collection in PCUs in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter, prospective, observational study in eight PCUs. Patients newly admitted to PCUs between June and September 2024 were included in this study. Based on the analysis requirement of 369 PRO responders and an assumed 60% response rate, 615 participants were targeted for enrollment (369\/0.60). Data on four symptoms (pain, shortness of breath, nausea, and worries or concerns) were collected weekly using the Integrated Palliative Outcome Scale (IPOS) from admission to week 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 550 patients were admitted to the PCUs; 388 self-reported patients were included in the analysis. The PRO response rate was &gt;\u200970% at all timepoints. The IPOS score decreased statistically only between admission and week 1 (pain,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; shortness of breath,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; nausea,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001; worries or concerns,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). A 1-point decrease in IPOS scores was observed for pain (from 2 to 1), shortness of breath (from 2 to 1), worries or concerns (from 2 to 1) from admission to week 1, and shortness of breath from week 3 to week 4 (from 1 to 0). In the \u201csevere\/moderate to absent\/mild\u201d and \u201ckeep absent\/mild\u201d categories, benchmark improvement rates were achieved only for nausea (70.7%; 90.0%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A 1-week regular evaluation using PROs may be feasible in PCUs in Japan. The greatest improvement in symptom scores occurred within the first week following PCU admission, with an observed plateau in subsequent weeks, suggesting that the first week may be important for assessing the quality of care in PCUs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12904-026-01990-9","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T18:24:45Z","timestamp":1769106285000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Monitoring patients\u2019 symptom improvement in palliative care units using patient-reported outcomes: a multicenter prospective observational study"],"prefix":"10.1186","volume":"25","author":[{"given":"Natsuko","family":"Katsube","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Sakashita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoko","family":"Kamohara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kousei","family":"Adachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritsuko","family":"Yabuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamiko","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syun","family":"Koike","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirofumi","family":"Abo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kento","family":"Masukawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Shima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsunori","family":"Miyashita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"1990_CR1","unstructured":"The Food and Drug Administration. Patient-reported outcome measures: use in medical product development to support labeling claims. 2009. https:\/\/www.fda.gov\/regulatory-information\/search-fda-guidance-documents\/patient-reported-outcome-measures-use-medical-product-development-support-labeling-claims. Accessed 21 Dec 2024."},{"key":"1990_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2015.12.340","author":"MH van den Beuken-van Everdingen","year":"2016","unstructured":"van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage. 2016. https:\/\/doi.org\/10.1016\/j.jpainsymman.2015.12.340.","journal-title":"J Pain Symptom Manage"},{"key":"1990_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2006.10.015","author":"SC Teunissen","year":"2007","unstructured":"Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage. 2007. https:\/\/doi.org\/10.1016\/j.jpainsymman.2006.10.015.","journal-title":"J Pain Symptom Manage"},{"key":"1990_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.06.007","author":"JP Solano","year":"2006","unstructured":"Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in Far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage. 2006. https:\/\/doi.org\/10.1016\/j.jpainsymman.2005.06.007.","journal-title":"J Pain Symptom Manage"},{"key":"1990_CR5","doi-asserted-by":"publisher","DOI":"10.1191\/0269216305pm1001oa","author":"K Oi-Ling","year":"2005","unstructured":"Oi-Ling K, Man-Wah DT, Kam-Hung DN. Symptom distress as rated by advanced cancer patients, caregivers and physicians in the last week of life. Palliat Med. 2005. https:\/\/doi.org\/10.1191\/0269216305pm1001oa.","journal-title":"Palliat Med"},{"key":"1990_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(06)70910-X","author":"E Basch","year":"2006","unstructured":"Basch E, Iasonos A, McDonough T, Barz A, Culkin A, Kris MG, et al. Patient versus clinician symptom reporting using the National cancer Institute common terminology criteria for adverse events: results of a questionnaire-based study. Lancet Oncol. 2006. https:\/\/doi.org\/10.1016\/S1470-2045(06)70910-X.","journal-title":"Lancet Oncol"},{"key":"1990_CR7","doi-asserted-by":"publisher","DOI":"10.1177\/0269216315589898","author":"C Bausewein","year":"2016","unstructured":"Bausewein C, Daveson BA, Currow DC, Downing J, Deliens L, Radbruch L, et al. EAPC white paper on outcome measurement in palliative care: improving practice, attaining outcomes and delivering quality services - recommendations from the European association for palliative care (EAPC) task force on outcome measurement. Palliat Med. 2016. https:\/\/doi.org\/10.1177\/0269216315589898.","journal-title":"Palliat Med"},{"key":"1990_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.06.014","author":"J Hoekstra","year":"2006","unstructured":"Hoekstra J, de Vos R, van Duijn NP, Schad\u00e9 E, Bindels PJ. Using the symptom monitor in a randomized controlled trial: the effect on symptom prevalence and severity. J Pain Symptom Manage. 2006. https:\/\/doi.org\/10.1016\/j.jpainsymman.2005.06.014.","journal-title":"J Pain Symptom Manage"},{"key":"1990_CR9","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.53.5948","author":"G Kotronoulas","year":"2014","unstructured":"Kotronoulas G, Kearney N, Maguire R, Harrow A, Di Domenico D, Croy S, et al. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol. 2014. https:\/\/doi.org\/10.1200\/JCO.2013.53.5948.","journal-title":"J Clin Oncol"},{"key":"1990_CR10","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05695-4","author":"C Graupner","year":"2021","unstructured":"Graupner C, Kimman ML, Mul S, Slok AHM, Claessens D, Kleijnen J, et al. Patient outcomes, patient experiences and process indicators associated with the routine use of patient-reported outcome measures (PROMs) in cancer care: a systematic review. Support Care Cancer. 2021. https:\/\/doi.org\/10.1007\/s00520-020-05695-4.","journal-title":"Support Care Cancer"},{"key":"1990_CR11","unstructured":"Palliative Care Outcome Collaboration. In: Patient outcomes in Palliative Care Australian National report for January to June 2024. 2024. https:\/\/www.uow.edu.au\/australasian-health-outcomes-consortium\/pcoc\/reports\/. Accessed 5 Feb 2025."},{"key":"1990_CR12","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2351-8","author":"DC Currow","year":"2015","unstructured":"Currow DC, Allingham S, Yates P, Johnson C, Clark K, Eagar K. Improving National hospice\/palliative care service symptom outcomes systematically through point-of-care data collection, structured feedback and benchmarking. Support Care Cancer. 2015. https:\/\/doi.org\/10.1007\/s00520-014-2351-8.","journal-title":"Support Care Cancer"},{"key":"1990_CR13","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-024-08771-1","author":"JJ Wu","year":"2024","unstructured":"Wu JJ, Tung YC. Did the palliative care outcomes collaboration (PCOC) program lead to improved end-of-life care quality and reduced non-beneficial treatments? Support Care Cancer. 2024. https:\/\/doi.org\/10.1007\/s00520-024-08771-1.","journal-title":"Support Care Cancer"},{"key":"1990_CR14","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-023-07912-2","author":"H Hirayama","year":"2023","unstructured":"Hirayama H, Satomi E, Kizawa Y, Miyazaki M, Tagami K, Sekine R, et al. The effect of palliative care team intervention and symptom improvement using patient-reported outcomes: a multicenter prospective observational study. Support Care Cancer. 2023. https:\/\/doi.org\/10.1007\/s00520-023-07912-2.","journal-title":"Support Care Cancer"},{"key":"1990_CR15","doi-asserted-by":"publisher","DOI":"10.2512\/jspm.17.171","author":"H Hirayama","year":"2022","unstructured":"Hirayama H, Satomi E, Kizawa Y, Miyazaki M, Tagami K, Sekine R, et al. Development of a patient registry system for specialized palliative care quality assessment using patient-reported outcomes: a multicenter pilot study. Palliat Care Res. 2022. https:\/\/doi.org\/10.2512\/jspm.17.171.","journal-title":"Palliat Care Res"},{"key":"1990_CR16","doi-asserted-by":"publisher","DOI":"10.1186\/s41687-023-00565-z","author":"N Ito","year":"2023","unstructured":"Ito N, Ishii Y, Aoyama M, Abo H, Sakashita A, Matsumura Y, et al. Routine patient assessment and the use of patient-reported outcomes in specialized palliative care in Japan. J Patient Rep Outcomes. 2023. https:\/\/doi.org\/10.1186\/s41687-023-00565-z.","journal-title":"J Patient Rep Outcomes"},{"key":"1990_CR17","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-021-06052-9","author":"C Graupner","year":"2021","unstructured":"Graupner C, Breukink SO, Mul S, Claessens D, Slok AHM, Kimman ML. Patient-reported outcome measures in oncology: a qualitative study of the healthcare professional\u2019s perspective. Support Care Cancer. 2021. https:\/\/doi.org\/10.1007\/s00520-021-06052-9.","journal-title":"Support Care Cancer"},{"key":"1990_CR18","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-022-33826-4.21","author":"OL Aiyegbusi","year":"2022","unstructured":"Aiyegbusi OL, Roydhouse J, Rivera SC, Kamudoni P, Schache P, Wilson R, et al. Key considerations to reduce or address respondent burden in patient-reported outcome (PRO) data collection. Nat Commun. 2022. https:\/\/doi.org\/10.1038\/s41467-022-33826-4.21.","journal-title":"Nat Commun"},{"key":"1990_CR19","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-01123-y","author":"E M\u00fcller","year":"2023","unstructured":"M\u00fcller E, Mayer-Steinacker R, Gencer D, Ke\u00dfler J, Alt-Epping B, Sch\u00f6nsteiner S, et al. Feasibility, use and benefits of patient-reported outcome measures in palliative care units: a multicentre observational study. BMC Palliat Care. 2023. https:\/\/doi.org\/10.1186\/s12904-022-01123-y.","journal-title":"BMC Palliat Care"},{"key":"1990_CR20","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-01109-w","author":"H Seipp","year":"2022","unstructured":"Seipp H, Haasenritter J, Hach M. State-wide implementation of patient-reported outcome measures (PROMs) in specialized outpatient palliative care teams (ELSAH): a mixed-methods evaluation and implications for their sustainable use. BMC Palliat Care. 2022. https:\/\/doi.org\/10.1186\/s12904-022-01109-w.","journal-title":"BMC Palliat Care"},{"key":"1990_CR21","doi-asserted-by":"publisher","DOI":"10.1177\/0269216313491619","author":"B Antunes","year":"2014","unstructured":"Antunes B, Harding R, Higginson IJ. Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers. Palliat Med. 2014. https:\/\/doi.org\/10.1177\/0269216313491619.","journal-title":"Palliat Med"},{"key":"1990_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.01.007","author":"CL Cain","year":"2018","unstructured":"Cain CL, Surbone A, Elk R, Kagawa-Singer M. Culture and palliative care: preferences, communication, meaning, and mutual decision making. J Pain Symptom Manage. 2018. https:\/\/doi.org\/10.1016\/j.jpainsymman.2018.01.007.","journal-title":"J Pain Symptom Manage"},{"key":"1990_CR23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP, STROBE Initiative. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007. https:\/\/doi.org\/10.1136\/bmj.39335.541782.AD.","journal-title":"BMJ"},{"key":"1990_CR24","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzab075","author":"S Clapham","year":"2021","unstructured":"Clapham S, Daveson BA, Allingham SF, Morris D, Blackburn P, Johnson CE, et al. Patient-reported outcome measurement of symptom distress is feasible in most clinical scenarios in palliative care: an observational study involving routinely collected data. Int J Qual Health Care. 2021. https:\/\/doi.org\/10.1093\/intqhc\/mzab075.","journal-title":"Int J Qual Health Care"},{"key":"1990_CR25","doi-asserted-by":"publisher","DOI":"10.1177\/0269216319854264","author":"FE Murtagh","year":"2019","unstructured":"Murtagh FE, Ramsenthaler C, Firth A, Groeneveld EI, Lovell N, Simon ST, et al. A brief, patient- and proxy-reported outcome measure in advanced illness: validity, reliability and responsiveness of the integrated palliative care outcome scale (IPOS). Palliat Med. 2019. https:\/\/doi.org\/10.1177\/0269216319854264.","journal-title":"Palliat Med"},{"key":"1990_CR26","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/082585979100700202","volume":"7","author":"E Bruera","year":"1991","unstructured":"Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care. 1991;7:6\u20139.","journal-title":"J Palliat Care"},{"key":"1990_CR27","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyy203.24","author":"H Sakurai","year":"2019","unstructured":"Sakurai H, Miyashita M, Imai K, Miyamoto S, Otani H, Oishi A, et al. Validation of the integrated palliative care outcome scale (IPOS)-Japanese version. Jpn J Clin Oncol. 2019. https:\/\/doi.org\/10.1093\/jjco\/hyy203.24.","journal-title":"Jpn J Clin Oncol"},{"key":"1990_CR28","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951521000018","author":"H Sakurai","year":"2021","unstructured":"Sakurai H, Miyashita M, Morita T, Naito AS, Miyamoto S, Otani H, et al. Comparison between patient-reported and clinician-reported outcomes: validation of the Japanese version of the integrated palliative care outcome scale for staff. Palliat Support Care. 2021. https:\/\/doi.org\/10.1017\/S1478951521000018.","journal-title":"Palliat Support Care"},{"key":"1990_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2013.11.009","author":"K Moens","year":"2014","unstructured":"Moens K, Higginson IJ, Harding R, EURO IMPACT. Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. J Pain Symptom Manage. 2014. https:\/\/doi.org\/10.1016\/j.jpainsymman.2013.11.009.","journal-title":"J Pain Symptom Manage"},{"key":"1990_CR30","unstructured":"Eastern Cooperative Oncology Group. Performance Status Score. Common Toxicity Criteria Version 2.0. 1999. http:\/\/ctep.cancer.gov\/protocolDevelopment\/electronic_applications\/docs\/ctcv20_4-30-992.pdf. Accessed 21 Dec 2024."},{"key":"1990_CR31","doi-asserted-by":"publisher","DOI":"10.1177\/0269216314551814","author":"M Masso","year":"2015","unstructured":"Masso M, Allingham SF, Banfield M, Johnson CE, Pidgeon T, Yates P, et al. Palliative care phase: inter-rater reliability and acceptability in a National study. Palliat Med. 2015. https:\/\/doi.org\/10.1177\/0269216314551814.","journal-title":"Palliat Med"},{"key":"1990_CR32","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1111\/j.1467-842X.2001.tb00294.x","volume":"25","author":"DA Bennett","year":"2001","unstructured":"Bennett DA. How can I deal with missing data in my study? Aust N Z J Public Health. 2001;25:464\u20139.","journal-title":"Aust N Z J Public Health"},{"key":"1990_CR33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2025.06.010","author":"Y Matsuda","year":"2025","unstructured":"Matsuda Y, Mori M, Tokoro A, Taniguchi Y, Aiki S, Takagi Y, et al. Minimal clinically important difference in the integrated palliative care outcome scale for cancer dyspnea. J Pain Symptom Manage. 2025. https:\/\/doi.org\/10.1016\/j.jpainsymman.2025.06.010.","journal-title":"J Pain Symptom Manage"},{"key":"1990_CR34","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2021.1573","author":"M Mori","year":"2022","unstructured":"Mori M, Morita T, Bruera E, Hui D. Prognostication of the last days of life. Cancer Res Treat. 2022. https:\/\/doi.org\/10.4143\/crt.2021.1573.","journal-title":"Cancer Res Treat"},{"key":"1990_CR35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2014.09.003","author":"D Hui","year":"2015","unstructured":"Hui D, dos Santos R, Chisholm GB, Bruera E. Symptom expression in the last seven days of life among cancer patients admitted to acute palliative care units. J Pain Symptom Manage. 2015. https:\/\/doi.org\/10.1016\/j.jpainsymman.2014.09.003.","journal-title":"J Pain Symptom Manage"},{"key":"1990_CR36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2023.09.015","author":"K Tagami","year":"2024","unstructured":"Tagami K, Chiu SW, Kosugi K, Ishiki H, Hiratsuka Y, Shimizu M, et al. Cancer pain management in patients receiving inpatient specialized palliative care services. J Pain Symptom Manage. 2024. https:\/\/doi.org\/10.1016\/j.jpainsymman.2023.09.015.","journal-title":"J Pain Symptom Manage"}],"container-title":["BMC Palliative Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12904-026-01990-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12904-026-01990-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12904-026-01990-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:58:50Z","timestamp":1781629130000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12904-026-01990-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1990"],"URL":"https:\/\/doi.org\/10.1186\/s12904-026-01990-9","relation":{},"ISSN":["1472-684X"],"issn-type":[{"value":"1472-684X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"assertion":[{"value":"12 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Ethics Review Committee of the Tohoku University Graduate School of Medicine (No. 2023-1-826) approved this study. The study qualified as a noninvasive observational study according to current Japanese law (data collected during routine practice). The requirement for informed consent from the patients was waived in accordance with the Japanese guidelines for noninvasive observational studies; however, notifications about this study were published and participants were ensured the opportunity to withdraw from participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"44"}}