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Jpn J Clin Oncol. 2014 Aug;44(8):718-28. doi: 10.1093/jjco/hyu075. Epub 2014 Jun 19.

A Japanese region-wide survey of the knowledge, difficulties and self-reported palliative care practices among nurses.

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Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi.
Palliative Care Partners, Tokyo.
Department of Nursing, Faculty of Medical Sciences, Teikyo University of Science, Tokyo.
Department of Adult Health Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo.
Department of Discharge Planning and Community Coordination, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata.
Department of Psycho-Oncology, National Cancer Center Hospital, East Kashiwa, Chiba.
Palliative Care Team, Division of Nursing, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka.
Consortium for Home Health Care in Nagasaki, University of Nagasaki, Nagasaki, Japan.
Division of Medical Oncology, Teikyo University School of Medicine, Tokyo, Japan.



We investigated palliative care knowledge, difficulty and self-reported practice among a region-wide sample of nurses who cared for cancer patients in Japan.


A cross-sectional questionnaire survey was distributed to 9 designated cancer centers, 17 community hospitals and 73 district nurse services across 4 regions in 2008. We used the Palliative Care Knowledge Test, the Palliative Care Difficulty Scale (five-point Likert scale) and the Palliative Care Self-Reported Practices Scale (five-point Likert scale).


In total, 2378 out of 3008 nurses (79%) responded. The knowledge, difficulty and self-reported practice scores were 51 ± 20%, 3.2 ± 0.7 and 3.7 ± 0.6, respectively. In the knowledge test, philosophy scored highest (88 ± 26%) and psychiatric problems scored lowest (37 ± 29%). In the difficulty test, alleviating symptoms scored most difficult (3.5 ± 0.8) and providing expert support scored least difficult (2.9 ± 1.3). In the self-reported practice questionnaire, pain and delirium relief were most frequently (4.0 ± 0.8) and least frequently (3.1 ± 0.9) provided, respectively. Knowledge was significantly poorer in community hospitals (P = 0.035); difficulty scores were significantly higher in community hospitals (P < 0.001) and district nurse services (P = 0.013); and self-reported practice scores were significantly poorer in community hospitals (P < 0.001) but superior in district nurse services (P < 0.001) than in designated cancer centers.


Knowledge, difficulty and self-reported practice for symptom management, particularly psychological symptoms, were insufficient, particularly in community hospitals. Education, expert support and adequate clinical experiences would help provide quality palliative care.


attitude; health knowledge; neoplasm; nurse; palliative care; practice; terminal care

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