title: How and why did a regional palliative care program lead to changes in a region? A qualitative analysis of the Japan OPTIM study.
abstract: BACKGROUND
  Improving palliative care is one of the major issues throughout the world.
  
  
  OBJECTIVE
  The primary aim of this study was to explore how and why a regional palliative care program led to changes in a region.
  
  
  METHODS
  As part of a nationwide mixed-methods study of a regional palliative care program, a qualitative study was performed with 101 health care professionals involved in the implementation of the program. In-depth interviews were done, focusing on perceived changes and the perceived reasons for the changes. We used thematic analyses.
  
  
  RESULTS
  Seven themes were identified as follows: 1) improved communication and cooperation among regional health care professionals; 2) increased confidence in the system to care for cancer patients at home; 3) improved knowledge/skills, practice, and perception of palliative care; 4) contribution to self-growth; 5) wide variability in perceived changes in the knowledge and perception of patients, family members, and the general public; 6) wide variability in the perceived regionwide effects of the project; and 7) unresolved issues. Participants emphasized improved communication and cooperation among regional health care professionals and stated a variety of ways of how communication and cooperation influenced daily practice. The main reasons for changes included regionwide interdisciplinary conferences and informal interactions at a variety of meetings.
  
  
  CONCLUSIONS
  This study advances understanding of how the regional palliative care program created a change in the region. The findings are useful for developing a conceptual framework and identifying key interventions to improve regional palliative care for clinicians, researchers, and policy makers.
authors: Hamamatsu Cancer Center, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
authors: Chizuru
authors: C
authors: Imura
authors: Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan. Electronic address: tmorita@sis.seirei.or.jp.
authors: Tatsuya
authors: T
authors: Morita
authors: Center for Cancer Control and Information Services, National Cancer Center, Chuo, Tokyo, Japan.
authors: Masashi
authors: M
authors: Kato
authors: Psycho-Oncology Division, Chiba Cancer Center, Chiba, Japan.
authors: Nobuya
authors: N
authors: Akizuki
authors: Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors: Hiroya
authors: H
authors: Kinoshita
authors: Shirahige Clinic, Nagasaki, Nagasaki, Japan.
authors: Yutaka
authors: Y
authors: Shirahige
authors: Department of Surgery, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan.
authors: Satoshi
authors: S
authors: Suzuki
authors: Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Shinjuku, Tokyo, Japan.
authors: Toru
authors: T
authors: Takebayashi
authors: Consortium for Home Health Care in Nagasaki, Nagasaki, Japan.
authors: Ritsuko
authors: R
authors: Yoshihara
authors: Division of Internal Medicine and Medical Oncology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan.
authors: Kenji
authors: K
authors: Eguchi
mesh_terms: D003142:Communication; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006699:Home Care Services; D006801:Humans; D007407:Interviews as Topic; D007564:Japan; D008297:Male; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000379:methods; D010348:Patient Care Team
keywords: Region; community; home; palliative care; social capital