Effects of a programme of interventions on regional comprehensive palliative care for patients with cancer: A mixed-methods study

Tatsuya Morita, Mitsunori Miyashita, Akemi Yamagishi, Miki Akiyama, Nobuya Akizuki, Kei Hirai, Chizuru Imura, Masashi Kato, Yoshiyuki Kizawa, Yutaka Shirahige, Takuhiro Yamaguchi, Kenji Eguchi

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: Improvement of palliative care is an important public health issue, but knowledge about how to deliver palliative care throughout a region remains inadequate. We used surveys and in-depth interviews to assess changes in the quality of palliative care after regional interventions and to gain insights for improvement of palliative care at a regional level. Methods: In this mixed-methods study, a comprehensive programme of interventions for regional palliative care for patients with cancer was implemented from April 1, 2008, to March 31, 2011 in Tsuruoka, Kashiwa, Hamamatsu, and Nagasaki in Japan. Interventions included education, specialist support, and networking. We surveyed patients, bereaved family members, physicians, and nurses before and after the interventions were introduced. We also did qualitative interviews with health-care professionals after the interventions were introduced. Primary endpoints were numbers of home deaths, coverage of specialist services, and patient-reported and family-reported qualities of care. This trial is registered with UMIN Clinical Trial Registry, Japan (UMIN000001274). Findings: 859 patients, 1110 bereaved family members, 911 physicians, and 2378 nurses provided analysable preintervention surveys; 857 patients, 1137 bereaved family members, 706 physicians, and 2236 nurses provided analysable postintervention surveys. Proportions of home deaths increased significantly, from 348 of 5147 (6·76%) before the intervention programme to 581 of 5546 (10·48%) after the intervention programme (p<0·0001). Furthermore, 194 of 221 (87·78%) family members of patients who died at home answered that these patients had wanted to die at home. The ratio of patients who received palliative care services to all patients who died of cancer increased significantly (from 0·31 to 0·50; p<0·0001). The patient-reported (effect size 0·14; adjusted p=0·0027) and family-reported (0·23; p<0·0001) qualities of care were significantly better after interventions than before interventions. Physician-reported and nurse-reported difficulties decreased significantly after the introduction of the interventions. Qualitative interviews showed improved communication and cooperation between health-care professionals because of greater opportunities for interactions at various levels. Interpretation: A regional programme of interventions could improve the quality of palliative care. Improvement of communication between health-care professionals is key to improvement of services. Funding: Third Term Comprehensive Control Research for Cancer Health and Labor Sciences Research Grants of the Ministry of Health, Labour and Welfare of Japan.

Original languageEnglish
Pages (from-to)638-646
Number of pages9
JournalThe Lancet Oncology
Volume14
Issue number7
DOIs
Publication statusPublished - 2013 Jun

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Palliative Care
Quality of Health Care
Neoplasms
Nurses
Japan
Interviews
Delivery of Health Care
Physicians
Communication
Organized Financing
Family Physicians
Health
Research
Registries
Public Health
Clinical Trials
Education

ASJC Scopus subject areas

  • Oncology

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Effects of a programme of interventions on regional comprehensive palliative care for patients with cancer : A mixed-methods study. / Morita, Tatsuya; Miyashita, Mitsunori; Yamagishi, Akemi; Akiyama, Miki; Akizuki, Nobuya; Hirai, Kei; Imura, Chizuru; Kato, Masashi; Kizawa, Yoshiyuki; Shirahige, Yutaka; Yamaguchi, Takuhiro; Eguchi, Kenji.

In: The Lancet Oncology, Vol. 14, No. 7, 06.2013, p. 638-646.

Research output: Contribution to journalArticle

Morita, T, Miyashita, M, Yamagishi, A, Akiyama, M, Akizuki, N, Hirai, K, Imura, C, Kato, M, Kizawa, Y, Shirahige, Y, Yamaguchi, T & Eguchi, K 2013, 'Effects of a programme of interventions on regional comprehensive palliative care for patients with cancer: A mixed-methods study', The Lancet Oncology, vol. 14, no. 7, pp. 638-646. https://doi.org/10.1016/S1470-2045(13)70127-X
Morita, Tatsuya ; Miyashita, Mitsunori ; Yamagishi, Akemi ; Akiyama, Miki ; Akizuki, Nobuya ; Hirai, Kei ; Imura, Chizuru ; Kato, Masashi ; Kizawa, Yoshiyuki ; Shirahige, Yutaka ; Yamaguchi, Takuhiro ; Eguchi, Kenji. / Effects of a programme of interventions on regional comprehensive palliative care for patients with cancer : A mixed-methods study. In: The Lancet Oncology. 2013 ; Vol. 14, No. 7. pp. 638-646.
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AU - Akiyama, Miki

AU - Akizuki, Nobuya

AU - Hirai, Kei

AU - Imura, Chizuru

AU - Kato, Masashi

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