Effects of Community-Wide Campaign on Perception of Palliative Care and Sense of Security Among Japanese Population Aged 40 to80 Years

Theoretical Background and research questions/hypothesis: Negative images and misconception about palliative care and homecare in general public are potential barriers for quality end-of life care. There have been few large-scale community-wide campaign in order to deliver appropriate information about palliative care and receiving care at home. We conducted a 3-year community intervention to distribute flyers, booklets, posters, and public lectures about community palliative care in four intervention regions in Japan and evaluated the effects of such information dissemination at the community level, and explored associations among levels of exposure to information sources, perceptions, knowledge and the sense of security achieved. 

Methods:  To select the general public in four intervention regions, we used a stratified two-stage random sampling of the general population (age range 40 to 80 years) from the Basic Resident Resister in each area. We selected 8000 participants (2000 from each area) for the pre-intervention survey and 4000 (1000 from each area) for the post-intervention survey. Over a period of 3 years, we provided flyers, 20-page booklet, a series of posters issued quarterly, and a DVD of a drama about community palliative care. We asked the local study teams to ensure these materials were available in all health care institutions and public facilities in their areas (municipal offices, libraries, etc.) and to provide public lectures during the intervention period to enhance public understanding of palliative care. The levels of exposure to the provided information were measured by a multiple-choice questionnaire after intervention. Perceptions of palliative care, knowledge about opioids, perception of receiving care at home, and sense of security obtained through questionnaires were compared between pre-and post-surveys and among different exposure categories. Multiple logistic regression analyses were used to estimate multivariable-adjusted odds ratios (ORs) for outcomes among the exposure categories within the intervention regions.

Results:  Overall perceptions of palliative care, opioids and receiving care at home, and sense of security improved significantly. Sub-analyses revealed that women, cancer survivors, and families of cancer patient were more exposed to these information than others. Multiple regression revealed that the extensive exposure category had significantly more positive perceptions of palliative care, receiving care at home, and opioid treatment to those of non-exposure category. Among different mediums, participants of public lecture showed significantly better perception of receiving care at home but there was no significant difference regarding knowledge about opioid.

Conclusions:  Our findings indicate that providing palliative care information via small media and lectures in the community is effective in improving perceptions of palliative care and knowledge about opioids among the community dwellers.  The acquisition of adequate knowledge about palliative care from various information sources may improve people’s sense of security regarding cancer.

Implications for research and/or practice:  In Japan, only 7 % of patients who die from cancer die at home, and over 80 % die in hospitals. Thus, reducing negative image of receiving palliative care at home has been the priority issue. Our study indicates that the intervention may have been effective in reducing such negative images among general public.