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J Pain Symptom Manage. 2014 Oct;48(4):602-10. doi: 10.1016/j.jpainsymman.2013.11.016. Epub 2014 Apr 2.

Changes in quality of care and quality of life of outpatients with advanced cancer after a regional palliative care intervention program.

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Department of Community Health Care, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. Electronic address:
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.
Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Palliative Care Partners, Tokyo, Japan.
Department of Palliative Medicine, National Cancer Center Hospital, East, Kashiwa, Chiba, Japan.
Shirahige Clinic, Nagasaki, Nagasaki, Japan.
Faculty of Environment and information Studies, Keio University, Tokyo, Japan.
Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.



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.


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).


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.


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.


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.


Palliative care; outpatient; patient; quality of care; region

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