• Chizuru Imura, Tatsuya Morita, Masashi Kato, Nobuya Akizuki, Hiroya Kinoshita, Yutaka Shirahige, Satoshi Suzuki, Toru Takebayashi, Ritsuko Yoshihara, and Kenji Eguchi.
• Hamamatsu Cancer Center, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
• J Pain Symptom Manage. 2014 May 1;47(5):849-59.

ContextImproving palliative care is one of the major issues throughout the world.ObjectivesThe primary aim of this study was to explore how and why a regional palliative care program led to changes in a region.MethodsAs 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.ResultsSeven 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. 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.ConclusionThis 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.Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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