Structure, availability, and organizational challenges of outpatient palliative care programmes in Japan: a nationwide survey.

IF 2.2 4区医学 Q3 ONCOLOGY

Japanese journal of clinical oncology Pub Date : 2025-09-05 DOI:10.1093/jjco/hyaf095

Yoko Nakazawa, Risa Yamazaki, Nobuyuki Yotani, Yoshiyuki Kizawa

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引用次数: 0

Abstract

Background: Despite the growing recognition of outpatient palliative care (OPC), the organizational structure and service availability of OPC programmes in Japan remain insufficiently characterized. This study evaluates the structure, availability, and organizational challenges of hospital-based OPC programmes across Japan, comparing community hospitals (CHs) with designated cancer hospitals (DCHs).

Methods: A nationwide cross-sectional survey, conducted in July 2022, targeted 624 hospitals, including those with registered palliative care teams from the Japanese Society of Palliative Medicine and DCHs. Programme leaders responded to a web-based questionnaire that included items on programme structure, service availability, and perceived organizational challenges. Logistic regression analysis was used to identify differences between CHs and DCHs.

Results: Among the 338 responding hospitals (response rate: 54.2%), 302 reported active OPC programmes. Only 35.5% provided OPC services 5 days weekly, and 16.0% offered limited care exclusively for in-hospital patients. Monthly OPC visits were significantly lower at CHs (mean: 34.3) than at DCHs (mean: 69.6). Underdeveloped services included psychological follow-ups (CHs: 27.9%; DCHs: 45.1%) and a consultation system for regional providers (CHs: 55.8%; DCHs: 64.6%). Human resource shortages were widely perceived, particularly among palliative care nurses (CHs: 67.4%; DCHs: 78.2%) and psychiatrists (CHs: 53.5%; DCHs: 60.4%). Notably, CHs experienced significantly higher odds of encountering limited (OR: 3.12, 95% CI: 1.59-6.45) and delayed (OR: 2.24, 95% CI: 1.17-4.35) specialist referrals.

Conclusions: OPC in Japan remains inadequately developed, with significant disparities between hospital types. Addressing critical human resource shortages and improving referral mechanisms through targeted policy interventions are essential to enhance OPC nationwide.

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日本门诊姑息治疗方案的结构、可用性和组织挑战：一项全国性调查。

背景：尽管门诊姑息治疗（OPC）得到了越来越多的认可，但日本门诊姑息治疗项目的组织结构和服务可得性仍然缺乏充分的特征。本研究通过比较社区医院（CHs）和指定癌症医院（DCHs），评估了日本各地基于医院的OPC项目的结构、可用性和组织挑战。方法：于2022年7月在全国范围内进行横断面调查，调查对象为624家医院，包括日本姑息医学学会和DCHs注册姑息治疗团队的医院。项目负责人回答了一份基于网络的调查问卷，其中包括项目结构、服务可用性和感知到的组织挑战。采用Logistic回归分析来确定CHs和DCHs之间的差异。结果：在答复的338家医院中（答复率：54.2%），302家报告了积极的OPC方案。只有35.5%的人提供每周5天的OPC服务，16.0%的人专门为住院病人提供有限的护理。CHs的每月OPC就诊次数（平均：34.3次）明显低于DCHs（平均：69.6次）。欠发达的服务包括心理随访(CHs: 27.9%；专科医生：45.1%)和区域医生咨询系统(专科医生：55.8%；DCHs: 64.6%)。普遍认为人力资源短缺，特别是在姑息治疗护士中(CHs: 67.4%；专科医生：78.2%)和精神科医生(专科医生：53.5%；DCHs: 60.4%)。值得注意的是，CHs遇到有限（OR: 3.12, 95% CI: 1.59-6.45）和延迟（OR: 2.24, 95% CI: 1.17-4.35）专家转诊的几率明显更高。结论：日本OPC的发展仍不充分，医院类型之间存在显著差异。通过有针对性的政策干预，解决严重的人力资源短缺问题和改进转诊机制，对于在全国范围内加强OPC至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Japanese journal of clinical oncology 医学-肿瘤学

CiteScore

3.70

自引率

8.30%

发文量

177

审稿时长

3-8 weeks

期刊介绍： Japanese Journal of Clinical Oncology is a multidisciplinary journal for clinical oncologists which strives to publish high quality manuscripts addressing medical oncology, clinical trials, radiology, surgery, basic research, and palliative care. The journal aims to contribute to the world"s scientific community with special attention to the area of clinical oncology and the Asian region. JJCO publishes various articles types including: ・Original Articles ・Case Reports ・Clinical Trial Notes ・Cancer Genetics Reports ・Epidemiology Notes ・Technical Notes ・Short Communications ・Letters to the Editors ・Solicited Reviews