ORIGINAL ARTICLE Exploring the perceived changes and the reasons why expected outcomes were not obtained in individual levels in a successful regional palliative care intervention trial: an analysis for interpretations Tatsuya Morita & Kazuki Sato & Mitsunori Miyashita & Miki Akiyama & Masashi Kato & Shohei Kawagoe & Hiroya Kinoshita & Yutaka Shirahige & Sen Yamakawa & Masako Yamada & Kenji Eguchi Received: 16 May 2013 / Accepted: 12 July 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Context The Japan Outreach Palliative Care Trial of Inte- grated Model (OPTIM) study, a mixed-methods study to evaluate the effects of a comprehensive regional palliative care program, revealed that the program provided broad positive outcomes at the regional level: increased home death, palliative care use, patient- and family-reported qual- ities of care, and health care professionals’ difficulties. Not all participants however obtained positive outcomes and thus exploring the reasons why expected outcomes were observed in individual levels could be of value. Aims The primary aims were to explore why expected out- comes were not obtained in individual participants, and the perceived changes in daily practices of physicians and nurses were explored. Subjects and methods Postintervention questionnaire survey on 857 patients, 1,137 bereaved family members, 706 phy- sicians, and 2,236 nurses were analyzed. Results The reasons for not achieving home deaths included unexpected rapid deterioration, caregivers unavailable, con- cerns about adequate responses to sudden changes, and physical symptoms uncontrolled, while lack of physician availability at home and lack of information from physicians were less frequently reported. The reasons for not receiving specialized palliative care services were the lack of recom- mendations from physicians and no information about T. Morita (*) Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka 433-8558, Japan e-mail: tmorita@sis.seirei.or.jp K. Sato : M. Miyashita Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan M. Akiyama Faculty of Environment and Information Studies, Keio University, Tokyo, Japan M. Kato Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan S. Kawagoe Aozora Clinic, Matsudo, Japan H. Kinoshita Department of Palliative Medicine , National Cancer Center Hospital East, Kashiwa, Japan Y. Shirahige Shirahige Clinic, Nagasaki, Japan S. Yamakawa Department of Palliative Care, Rokko Hospital, Kobe, Japan M. Yamada Research Center for Development of Nursing Practice, St. Luke’ s College of Nursing, Tokyo, Japan K. Eguchi Division of Internal Medicine and Medical Oncology, Teikyo University School of Medicine, Tokyo, Japan Support Care Cancer DOI 10.1007/s00520-013-1910-8