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J Pain Symptom Manage. 2015 Aug;50(2):232-40. doi: 10.1016/j.jpainsymman.2015.02.025. Epub 2015 Apr 4.

Improvements in Physicians' Knowledge, Difficulties, and Self-Reported Practice After a Regional Palliative Care Program.

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Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. Electronic address:
Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Shinjo Clinic, Kobe, Hyogo, Japan.
Department of Community Health Care, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Department of Surgery, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan.
Department of Palliative Medicine, National Cancer Center Hospital, East, Kashiwa, Chiba, Japan.
Shirahige Clinic, Nagasaki, Nagasaki, Japan.
Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Division of Medical Oncology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.



Although several studies have explored the effects of regional palliative care programs, no studies have investigated the changes in physician-related outcomes.


The primary aims of this study were to: (1) clarify the changes in knowledge, difficulties, and self-reported practice of physicians before and after the intervention, (2) explore the potential associations between the level of physicians' participation in the program and outcomes, and (3) identify the reasons and characteristics of physicians who did not participate in the program.


As a part of the regional palliative care intervention trial, questionnaires were sent to physicians recruited consecutively to obtain a representative sample of each region. Physician-reported knowledge, difficulty of palliative care, and self-perceived practice were measured using the Palliative Care Knowledge Test, Palliative Care Difficulty Scale, and Palliative Care Self-Reported Practice Scale (PCPS), respectively. The level of their involvement in the program and reason for non-participation were ascertained from self-reported questionnaires.


The number of eligible physicians identified was 1870 in pre-intervention and 1763 in post-intervention surveys, and we obtained 911 and 706 responses. Total scores of the Palliative Care Knowledge Test, PCPS, and PCPS were significantly improved after the intervention, with effect sizes of 0.30, 0.52, and 0.17, respectively. Physicians who participated in workshops more frequently were significantly more likely to have better knowledge, less difficulties, and better self-reported practice.


After the regional palliative care program, there were marked improvements in physicians' knowledge and difficulties. These improvements were associated with the level of physicians' participation in the program.


Physician; difficulty; knowledge; palliative care; regional palliative care

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