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ABSTRACT

Objectives: The aim of this study was to develop a comprehensive community palliative care system with citizen involvement.
Methods: Based on the structure-process-outcome model developed by Donabedian in 1988, the components of the comprehensive community palliative care system with citizen involvement have been derived from the results of the buzz sessions by working groups, literature reviews, overseas study tours and international comparative studies. In the working process of systematization of the findings, the following issues are identified.
Results:
1. Considering the widening regional disparities in various aspects of society, it is critically important to develop the comprehensive new system in a broad framework. In the implementation and development of the comprehensive new system in the community, it is necessary to suggest a flex model in structure and function of the system by taking the positive and negative elements of the region into consideration.
2. It should be remembered that the reassessment of the structural and functional strength and weakness of the existing hospitals, clinics, home nursing centers and public health centers should be made. Consequently, the functional enhancement of those facilities with inefficiency is required for the useful community medical systems. It is also crucial to advance the ability of a coordinator who plays important roles in promotion and coordination of the community palliative care services to which citizens can have better access.
3. In building the community where the citizens can live until the end of their life in fulfillment, the citizen involvement in community activities is the key to success. Thus, the development of continuing volunteer educational programs in health care aimed at the citizens is in strong need.
Conclusions: In Japan, it is necessary for us to develop the comprehensive palliative care system in a broad framework to provide appropriate palliative care for citizens in the community.

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