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Exploring the perceived changes and the reasons why expected outcomes were not obtained in individual levels in a successful regional palliative care intervention trial: an analysis for interpretations

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Abstract

Context

The Japan Outreach Palliative Care Trial of Integrated Model (OPTIM) study, a mixed-methods study to evaluate the effects of a comprehensive regional palliative care program, revealed that the program provided broad positive outcomes at the regional level: increased home death, palliative care use, patient- and family-reported qualities of care, and health care professionals’ difficulties. Not all participants however obtained positive outcomes and thus exploring the reasons why expected outcomes were observed in individual levels could be of value.

Aims

The primary aims were to explore why expected outcomes were not obtained in individual participants, and the perceived changes in daily practices of physicians and nurses were explored.

Subjects and methods

Postintervention questionnaire survey on 857 patients, 1,137 bereaved family members, 706 physicians, and 2,236 nurses were analyzed.

Results

The reasons for not achieving home deaths included unexpected rapid deterioration, caregivers unavailable, concerns about adequate responses to sudden changes, and physical symptoms uncontrolled, while lack of physician availability at home and lack of information from physicians were less frequently reported. The reasons for not receiving specialized palliative care services were the lack of recommendations from physicians and no information about palliative care services. The reason for evaluating the quality of palliative care as not high was that clinicians tried to relieve symptoms, but there were limited effects and insufficient time. Many physicians and nurses reported that they became more aware of palliative care, that the availability of palliative care specialists and knowledge about palliative care improved, and that they cooperated with other regional health care providers more easily.

Conclusion

The OPTIM study seemed to succeed in optimizing physician availability at home, improves physician information about home care, achieved maximum efforts to relieve patient distress by clinicians, and increased communication among regional health care professionals. To achieve further better outcomes, multiple interventions to the health care system to be performed on the basis of a comprehensive regional palliative care program are proposed.

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Acknowledgment

The authors thank Nobuya Akizuki, MD, PhD, (Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East), Kei Hirai, PhD, (Graduate School of Human Sciences; Center for the Study of Communication-Design; Department of Complementary and Alternative Medicine, Graduate School of Medicine, Osaka University), Yoshiyuki Kizawa, MD, ( Department of Medical Social Service, Center for Palliative and Supportive Care, Graduate School, University of Tsukuba), Satoshi Suzuki, MD, (Department of Surgery, Tsuruoka Municipal Shonai Hospital ), Toru Takebayashi, MD, PhD, (Department of Preventive Medicine and Public Health, School of Medicine, Keio University), Megumi Umeda, RN, (Palliative Care Partners), and Akemi Yamagishi, RN, PhD, (Department of Preventive Medicine and Public Health, School of Medicine, Keio University) for their contribution as essential members of the research team. The authors thank Chizuru Imura, RN (Hamamatsu Cancer Center, Seirei Mikatahara General Hospital) for the construction of the questionnaire used in this study.

Conflict of interest

This study was funded by the Third Term Comprehensive Control Research for Cancer Health and Labor Sciences Research Grants in Japan. The authors have no conflicts of interest. All authors can access all primary data and agree to allow the journal to review the data if requested.

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Authors and Affiliations

  1. Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Tatsuya Morita

  2. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan

    Kazuki Sato & Mitsunori Miyashita

  3. Faculty of Environment and Information Studies, Keio University, Tokyo, Japan

    Miki Akiyama

  4. Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Masashi Kato

  5. Aozora Clinic, Matsudo, Japan

    Shohei Kawagoe

  6. Department of Palliative Medicine , National Cancer Center Hospital East, Kashiwa, Japan

    Hiroya Kinoshita

  7. Shirahige Clinic, Nagasaki, Japan

    Yutaka Shirahige

  8. Department of Palliative Care, Rokko Hospital, Kobe, Japan

    Sen Yamakawa

  9. Research Center for Development of Nursing Practice, St. Luke’s College of Nursing, Tokyo, Japan

    Masako Yamada

  10. Division of Internal Medicine and Medical Oncology, Teikyo University School of Medicine, Tokyo, Japan

    Kenji Eguchi

Authors
  1. Tatsuya Morita
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  2. Kazuki Sato
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  3. Mitsunori Miyashita
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  4. Miki Akiyama
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  5. Masashi Kato
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  6. Shohei Kawagoe
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  7. Hiroya Kinoshita
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  8. Yutaka Shirahige
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  9. Sen Yamakawa
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  10. Masako Yamada
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  11. Kenji Eguchi
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Corresponding author

Correspondence to Tatsuya Morita.

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Morita, T., Sato, K., Miyashita, M. et al. Exploring the perceived changes and the reasons why expected outcomes were not obtained in individual levels in a successful regional palliative care intervention trial: an analysis for interpretations. Support Care Cancer 21, 3393–3402 (2013). https://doi.org/10.1007/s00520-013-1910-8

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  • DOI: https://doi.org/10.1007/s00520-013-1910-8

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