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.
BACKGROUND
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.


OBJECTIVE
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.


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.


CONCLUSIONS
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.
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, tmorita@sis.seirei.or.jp.
Tatsuya
T
Morita
Kazuki
K
Sato
Mitsunori
M
Miyashita
Miki
M
Akiyama
Masashi
M
Kato
Shohei
S
Kawagoe
Hiroya
H
Kinoshita
Yutaka
Y
Shirahige
Sen
S
Yamakawa
Masako
M
Yamada
Kenji
K
Eguchi
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003191:Comprehensive Health Care / Q000379:methods / Q000592:standards; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D009726:Nurses / Q000523:psychology; D010166:Palliative Care / Q000379:methods* / Q000523:psychology / Q000592:standards*; D017060:Patient Satisfaction; D010465:Perception; D010820:Physicians / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome