Changes in Quality of Care and Quality of Life of Outpatients With Advanced Cancer After a Regional Palliative Care Intervention Program

• Published in: Journal of pain and symptom management 2014-10, Vol.48 (4), p.602-610
• Main Authors: Yamagishi, Akemi, RN, PhD, Sato, Kazuki, RN, PhD, Miyashita, Mitsunori, RN, PhD, Shima, Yasuo, MD, Kizawa, Yoshiyuki, MD, PhD, Umeda, Megumi, RN, CNS, Kinoshita, Hiroya, MD, Shirahige, Yutaka, MD, PhD, Akiyama, Miki, PhD, Yamaguchi, Takuhiro, PhD, Morita, Tatsuya, MD
• Format: Article
• Language: English
• Subjects: Aged; Ambulatory Care - psychology; Ambulatory Care - standards; Ambulatory Care - statistics & numerical data; Anesthesia & Perioperative Care; Biological and medical sciences; Female; Health Care Surveys; Humans; Japan - epidemiology; Male; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasms - epidemiology; Neoplasms - psychology; Neoplasms - therapy; outpatient; Outpatients - psychology; Outpatients - statistics & numerical data; Pain Medicine; Palliative care; Palliative Care - standards; Palliative Care - statistics & numerical data; patient; Patient Satisfaction - statistics & numerical data; Pharmacology. Drug treatments; Prevalence; Program Evaluation; quality of care; Quality of Health Care - statistics & numerical data; Quality of Life - psychology; region; Treatment Outcome; Tumors
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2013.11.016

Abstract Context 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. Objectives 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. Conclusion 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.