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J Pain Symptom Manage. 2014 May;47(5):849-59. doi: 10.1016/j.jpainsymman.2013.06.002. Epub 2013 Aug 24.

How and why did a regional palliative care program lead to changes in a region? A qualitative analysis of the Japan OPTIM study.

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Hamamatsu Cancer Center, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan. Electronic address:
Center for Cancer Control and Information Services, National Cancer Center, Chuo, Tokyo, Japan.
Psycho-Oncology Division, Chiba Cancer Center, Chiba, Japan.
Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Shirahige Clinic, Nagasaki, Nagasaki, Japan.
Department of Surgery, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan.
Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Shinjuku, Tokyo, Japan.
Consortium for Home Health Care in Nagasaki, Nagasaki, Japan.
Division of Internal Medicine and Medical Oncology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan.



Improving palliative care is one of the major issues throughout the world.


The primary aim of this study was to explore how and why a regional palliative care program led to changes in a region.


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.


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.


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.


Region; community; home; palliative care; social capital

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