Impact of a Six-Year Project to Enhance the Awareness of Community-Based Palliative Care on the Place of Death.

Nozomu Murakami,Tatsuya Morita,Kouichi Tanabe,Shiro Koseki,Ryuji Hayashi,Yasunaga Fujikawa,Kazunori Nakajima,Shinya Kajiura

doi:10.1089/jpm.2017.0696

Abstract

Object: To examine the clinical outcomes of a project to enhance the awareness of community-based palliative care (awareness-enhancing project), focusing on home death and care rates in communities.Methods: A single-center study on community-based intervention was conducted. The awareness-enhancing project, consisting of three intervention approaches (outreach, palliative care education for community-based medical professionals, and information-sharing tool use), was executed, and changes in the home death rate in the community were examined.Results: The home death rate markedly exceeded the national mean from 2010. In 2012–2013, it was as high as 19.9%, greater than the previous 5.9% (p = 0.001). Through multivariate analysis, the participation of home care physicians and visiting nurses in a palliative care education program, and patients' Palliative Prognostic Index values were identified as factors significantly influencing the home death rate.Conclusion: The three intervention approaches time dependently increased the home death rate as a clinical outcome in the community, although they targeted limited areas. These approaches may aid in increasing the number of individuals who die in their homes.

Highlights

The number of patients who desire palliative home care has been reported as potentially large[1,2]; many people do not realistically consider home death in Japan without general practitioner systems.[3,4]. In such a situation, increasing the number of those who die in their homes through palliative home care is an approach to fulfill patient desires
To resolve these problems as much as possible and increase the home death rate, we developed and executed a project to enhance the awareness of community-based palliative care, consisting of three intervention approaches: (1) outreach visits by a hospital palliative care team (PCT) to compensate for insufficient functions in the community using the program; (2)
Optional care procedures performed by the PCT replacing home care physicians included the following: central venous port maintenance (36), continuous subcutaneous morphine administration (26), delirium management (17), expensive drug administration (12: 7 cases of continuous subcutaneous octreotide acetate administration and 5 cases of zoledronic acid administration), ascites puncture for drainage (8), and home oxygen therapy (4)

Summary

Introduction

The number of patients who desire palliative home care has been reported as potentially large[1,2]; many people do not realistically consider home death in Japan without general practitioner systems.[3,4] In such a situation, increasing the number of those who die in their homes through palliative home care is an approach to fulfill patient desires. (1) insufficient primary-care physicians well-versed in palliative care, (2) insufficient basic palliative care-related knowledge and skills of community medical staff, and (3) their widely varying specialties make informationsharing difficult. To resolve these problems as much as possible and increase the home death rate, we developed and executed a project to enhance the awareness of community-based palliative care (awareness-enhancing project), consisting of three intervention approaches: (1) outreach visits by a hospital palliative care team (PCT) to compensate for insufficient functions in the community using the program (outreach program); (2)

Methods

Results

Conclusion