Changes in quality of care and quality of life of outpatients with advanced cancer after a regional palliative care intervention program.
BACKGROUND
A recent mixed-methods study to evaluate the effects of a comprehensive regional palliative care program, the Japan Outreach Palliative Care Trial of the Integrated Model study, achieved broad positive outcomes at a regional level. This is a secondary analysis of patient outcomes.


OBJECTIVE
The primary aims were to explore: 1) the changes in domains of patient-reported quality of care and quality of life after interventions, and 2) the changes in quality of care and quality of life of patients with different characteristics (i.e., performance status, age, and anticancer treatment).


METHODS
A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings participated in questionnaire surveys before and after regional intervention. Responses were obtained from 859 of 1880 and 857 of 2123 in the pre- and postintervention surveys, respectively.


RESULTS
All subdomain scores of the quality of care, except for help with decision making, significantly improved in the postintervention survey. The percentages of the patients who reported that improvement was necessary decreased from 13% to 5.0%. Although there were no or only a marginally significant difference in total and subdomain scores of quality of life between preintervention and postintervention surveys, the subgroups of patients with a poor performance status and those receiving no anticancer treatment achieved a significant improvement in the quality of life.


CONCLUSIONS
Although average changes in patient-reported outcomes were relatively small in the total sample of patients, the intervention seemed to provide tangible benefits for the patients with poor general conditions. A future regional intervention trial should include patient outcomes in those with a poor general condition to evaluate the net effects of the program.
Department of Community Health Care, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. Electronic address: tmorita@sis.seirei.or.jp.
Akemi
A
Yamagishi
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Kazuki
K
Sato
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Mitsunori
M
Miyashita
Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.
Yasuo
Y
Shima
Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Yoshiyuki
Y
Kizawa
Palliative Care Partners, Tokyo, Japan.
Megumi
M
Umeda
Department of Palliative Medicine, National Cancer Center Hospital, East, Kashiwa, Chiba, Japan.
Hiroya
H
Kinoshita
Shirahige Clinic, Nagasaki, Nagasaki, Japan.
Yutaka
Y
Shirahige
Faculty of Environment and information Studies, Keio University, Tokyo, Japan.
Miki
M
Akiyama
Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Takuhiro
T
Yamaguchi
Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
Tatsuya
T
Morita
D000368:Aged; D000553:Ambulatory Care / Q000523:psychology* / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015995:Prevalence; D015397:Program Evaluation; D011787:Quality of Health Care / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome
Palliative care; outpatient; patient; quality of care; region