Progressive development and enhancement of palliative care services in Japan: nationwide surveys of designated cancer care hospitals for three consecutive years.
BACKGROUND
Policymaking plays an important role in national palliative care services. The Japanese Cancer Control Act was implemented in 2006.


OBJECTIVE
To evaluate changes in the structure and processes of palliative care services after implementation of the Cancer Control Act.


METHODS
We conducted annual nationwide surveys in designated cancer care hospitals (DCCHs, n = 349) between 2008 and 2010. The 65-item questionnaire was divided into seven domains: institutional framework, information to patient and family, practice of palliative care, activities of the palliative care teams (PCTs), members of PCTs, regional medical cooperation, and education. Increasing trends were tested using generalized estimating equation models.


RESULTS
The response rates were ≥ 99%. All domains showed an increasing trend (P < 0.001). There were significant increases in full-time PCT physicians (27.4%-45.7%, P(trend) < 0.001), full-time PCT nurses (38.9%-88.0%, P(trend) < 0.001), and the median number of annual referrals to PCTs (60-80 patients, P < 0.001). Essential drugs were available in most DCCHs from baseline. Although outpatient clinics increased significantly (27.0%-58.9%, P(trend) < 0.001), community outreach programs did not (9.0%-12.6%, P = 0.05). Basic education was actively introduced for in-hospital physicians and nurses (78.2% and 91.4% in 2010), but often unavailable for regional health care providers (basic education for regional physicians and nurses: 63.9% and 71.1% in 2010).


CONCLUSIONS
The Cancer Control Act promoted the development and enhancement of palliative care services in DCCHs. Regional medical cooperation and education are the future challenges of palliative care in Japan.
Department of Palliative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. Electronic address: maeda@pm.med.osaka-u.ac.jp.
Isseki
I
Maeda
Department of Palliative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Satoru
S
Tsuneto
Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Mitsunori
M
Miyashita
Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
Tatsuya
T
Morita
Palliative Care Partners Co., Ltd., Minato-ku, Tokyo, Japan.
Megumi
M
Umeda
Department of Palliative Care, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan.
Miwa
M
Motoyama
Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan.
Fumie
F
Kosako
Department of Surgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan.
Yoshihisa
Y
Hama
Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Yoshiyuki
Y
Kizawa
Faculty of Medicine, Division of Health Innovation and Nursing, University of Tsukuba, Ibaraki, Japan.
Tomoyo
T
Sasahara
Division of Medical Oncology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
Kenji
K
Eguchi
D002173:Cancer Care Facilities / Q000331:legislation & jurisprudence*; D004517:Education, Professional; D006801:Humans; D007564:Japan; D010166:Palliative Care / Q000331:legislation & jurisprudence* / Q000379:methods*; D010348:Patient Care Team; D011795:Surveys and Questionnaires; D000078329:Workforce
Palliative care services; designated cancer care hospital; nationwide survey; palliative care education; regional medical cooperation