Development of an effective home palliative care system that adopts a multidisciplinary team approach

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This study looked at the team approach to home palliative care for terminal cancer patients that has been pioneered in Okayama over the past several years (Okayama palliative care model), This team approach involves personnel from multiple disciplines. In this study, we first clarified the appropriate conditions for smooth implementation of the model from a qualitative study. Then, as the final outcome, we conducted a survey of satisfaction of the bereaved families.The results of the first qualitative study were: (1) regular study sessions and joint conferences with the participation of both the primary care and palliative care teams, (2) adequate sharing of information, (3) understanding by the primary team of the special type of cam provided by the palliative care team, (4) appropriate sharing of roles between the two teams, (5) respect of the primary care team, (6) emphasis on the central role of the visiting nurse station, (7) creation of an emergency system, (8) use of care insurance, and (9) cooperation with welfare professionals.Next, we first developed an official Japanese version of the FAMCARE Scale, which is a scale developed to survey the satisfaction of the bereaved families. The questionnaire was sent to 83 surviving family members of patients who had received care under the Okayama model. The mean score for the survey was 3.94 points (out of a possible 5). Responses of "satisfied" or better were received by more than 50% of respondents for nearly all items. The ratings were high for "pain relief" responses by medical specialists to questions," "physicians' response to family requests to meet and talk," "physicians' attention to symptoms," and "time taken by primary physician for patient." Conversely, issues remain in items such as "always ensuring a bed for hospitalization." Only 44% of respondents were satisfied with nursing care, suggesting the need for environmental improvements to ease the burden on families.