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

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).

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.

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.

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.