How and Why Did a Regional Palliative Care Program Lead to Changes in a Region? A Qualitative Analysis of the Japan OPTIM Study

作者：Imura Chizuru; Morita Tatsuya^*; Kato Masashi; Akizuki Nobuya; Kinoshita Hiroya; Shirahige Yutaka; Suzuki Satoshi; Takebayashi Toru; Yoshihara Ritsuko; Eguchi Kenji

来源：Journal of Pain and Symptom Management, 2014, 47(5): 849-859.

DOI：10.1016/j.jpainsymman.2013.06.002

• Region
• palliative care
• home
• community
• social capital

Context. Improving palliative care is one of the major issues throughout the world. %26lt;br%26gt;Objectives. The primary aim of this study was to explore how and why a regional palliative care program led to changes in a region. %26lt;br%26gt;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. %26lt;br%26gt;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. %26lt;br%26gt;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. %26lt;br%26gt;Conclusion. 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.

• 出版日期2014-5