Current position
-Director, Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital
-Vice-director, Seirei Mikatahara General Hospital
-Adjunct Professor, Kyoto University
Education and experience
After graduated from Kyoto University of Medicine in 1992, he completed a residency program in internal medicine at the Seirei Mikatahara General Hospital, an 800-bed general hospital located in western area of the Shizuoka prefecture, Japan, 1992-1993. He was a staff medical doctor of the Seirei Hospice, one of the most oldest inpatient hospices (palliative care units) in Japan, and provided his most of time to patient care in inpatient and home care settings from 1993-2002. In doing so, he became a research fellow at the Psycho-Oncology Division of the National Cancer Center Research Institute East, Japan, in 2000-2001. He started a hospital palliative care program in 2002 as the Head of Palliative Care Team of the Seirei Mikatahara General Hospital. He is now the Director of the Department of Palliative and Supportive Care from 2005, and the Vice-director of the Seirei Mikatahara General Hospital.
Academic contribution
He is a member of the Japanese Association of Palliative Medicine. Editorial boards of Journal of Pain and Symptom Management (2004-), Journal of Palliative Care (2004-), and Journal of Palliative Medicine (2009-). Associate Editor of the Japanese Journal of Clinical Oncology (2009-). One of editors of the Textbook of Palliative Medicine. He is participating into multiple MHLW-granted research, and published more than 100 scientific papers. Main research topics included; delirium, sedation, hydration, suffering, end-of-life issues, and care delivery.
Regional Palliative Care Intervention Study using the Mixed-methods Design
Abstract
In this presentation, this author first summarize the current status of palliative care in Japan, and then share the study results and research implication of the OPTIM study, a regional palliative care intervention study using the mixed-methods design. Finally, the role of complex intervention study in palliative care field is discussed.
For the OPTIM study, please see the following major papers. Major results is published in the Lancet Oncology 2013; 14: 638-46. Qualitative analysis is published in the Pain and Symptom management: Imura C and Morita T et al (How and why did a regional palliative care program lead to changes in a region? A qualitative analysis of the Japan OPTIM Study. doi:pii: S0885-3924(13)00385-0). The third additional analyses to identify the reasons why expected outcomes were not obtained in individual levels in a successful regional palliative care intervention trial have been published in the Supportive care in Cancer 2013;21:3393-402. Further additional analyses are currently performing and some will be published by the time of conference.
In summary, the OPTIM study was a mixed-methods study, and a regional comprehensive palliative care program for cancer patients was implemented from April 2008 through March 2011 in four regions of Japan. Intervention was comprehensive and included education, specialist support, and networking. Primary end-points included home death, coverage of specialist services, and patient- and family-reported qualities of care. We performed a mail survey involving patients, bereaved family members, physicians, and nurses as a nearly region-representative sample before and after the intervention. The patients were adult outpatients with a metastatic or recurrent cancer of the lung, esophagus, stomach, colon, rectum, pancreas, liver, biliary system, kidney, prostate, bladder, breast, ovary, or uterus; the families were adult family member of the cancer patients who had died in an healthcare institution or at home in each region; and the physicians and nurses were hospital physicians and nurses working in cancer-related specialties, a representative physician of general practice clinics, or all district nurses with clinical experience of 3 years or longer. A qualitative interview study involved 101 healthcare professionals. A total of 859 and 857 patients, 1,110 and 1,137 bereaved family members, 911 and 706 physicians, and 2,378 and 2,236 nurses were enrolled in the preintervention and postintervention surveys, respectively. The percentage of home deaths increased from 6.8% to 10.5% (P<0.0001), and this increase was significantly greater than that in national data (6.7% to 7.7%, P<0.0001). Moreover, 88% of family members confirmed that patients who died at home had preferred home death, and the care burden showed no significant increase. The ratio of patients who received palliative care services increased significantly (0.31 to 0.50, P<0.0001). The patient- and family-reported qualities of care were significantly better after intervention (effect size, 0.14 and 0.23; P=0.0027 and <0.0001; respectively). Physician- and nurse-reported difficulties, especially regarding communication and coordination, decreased significantly (effect size, 0.52 and 0.59; P<0.0001 and <0.0001; respectively). The qualitative interview study revealed improved communication and cooperation among professionals because of greater opportunities for interactions at a variety of levels. A regional comprehensive palliative care program could improve the global quality of palliative care.
This study clarified the comprehensive effects of a regional palliative care program on a broad range of outcomes: place of death, use of specialized palliative care services, patient- and family-perceived quality of care, quality of life of patients, family care burden, and physician- and nurse-perceived difficulties and knowledge. While the program had an overall benefit, the largest impact revealed in both quantitative and qualitative studies was improved communication among healthcare professionals. Our study added important insight in the crucial value of communication among healthcare professionals to improve palliative care at a regional level.
Our study group learned a lot form this study, and will share the role of complex intervention study as a probably very useful research strategy in palliative care fields.
