title: Factors that influence physicians in providing palliative care in rural communities in Taiwan.
abstract: OBJECTIVE
  To identify the willingness, influencing factors, and educational needs of community physicians in providing palliative care in the rural areas of Taiwan.
  
  
  METHODS
  A questionnaire was sent to all medical directors of the 140 government health stations assigned to the rural areas of Taiwan.
  
  
  RESULTS
  The overall response rate was 62.8% with 85 valid questionnaires retrieved. The majority of respondents (84.7%) expressed a willingness to provide palliative care if they encountered an advanced cancer patient. However, they would limit their services to consultation and referral (93.0% and 87.5%, respectively), and were less likely to provide home visits (40.3%) or bereavement support of the family (29.2%). With respect to knowledge, the accurate answers to the philosophy/principles and clinical practice of palliative care were 93.4% and 57.3%, respectively. Regarding attitudes, the highest score item in perceiving the threat about providing palliative care was "uncomfortable to meet and take care of the advanced cancer patient." The highest score item in perceiving barriers was "providing palliative care may shorten patient's life, just like euthanasia." The results of stepwise logistic regression analysis for the willingness to provide home visits showed that only the subjective norms remained in the model (OR = 1.87, 95% CI = 1.17-3.01). Educational needs expressed by the respondents were ranked as follows: emotional support to, communication skills with, and bereavement support for the advanced cancer patients and their relatives.
  
  
  CONCLUSIONS
  Effective training courses that emphasize the practical knowledge of palliative care for community physicians, incorporating palliative care into medical education particularly in terms of communication skills and ethical roles, and active health policy administration including insurance payments, are important for the enhancement of community palliative care in Taiwan.
authors.affiliation: Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Wen-Jing
authors.initials: WJ
authors.lastname: Liu
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Hu
authors.forename: Yie-Fong
authors.initials: YF
authors.lastname: Chiu
authors.forename: Tai-Yuan
authors.initials: TY
authors.lastname: Chiu
authors.forename: Bee-Hong
authors.initials: BH
authors.lastname: Lue
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Susumn
authors.initials: S
authors.lastname: Wakai
mesh_terms: D000328:Adult; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology*; D012017:Referral and Consultation; D019035:Rural Health Services / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013624:Taiwan
references.citation: BMJ. 1990 Sep 1;301(6749):415-7
references.pmid: 1967134
references.citation: Br J Gen Pract. 2000 Aug;50(457):653-4
references.pmid: 11042919
references.citation: Lancet. 1971 May 29;1(7709):1115-8
references.pmid: 4102635
references.citation: Fam Pract. 1991 Dec;8(4):356-9
references.pmid: 1800200
references.citation: Med Care. 1991 Sep;29(9):841-52
references.pmid: 1921535
references.citation: J Palliat Care. 1993 Summer;9(2):33-8
references.pmid: 7690852
references.citation: J Pain Symptom Manage. 1997 Nov;14(5):265-73
references.pmid: 9392919
references.citation: J Adv Nurs. 1996 Jan;23(1):126-37
references.pmid: 8708208
references.citation: Palliat Med. 1998 Sep;12(5):317-32
references.pmid: 9924595
references.citation: Br J Gen Pract. 1994 Jul;44(384):297-300
references.pmid: 8068375
references.citation: Soc Sci Med. 1993 May;36(9):1151-9
references.pmid: 8511644
references.citation: Cancer Nurs. 1992 Apr;15(2):109-15
references.pmid: 1617616
references.citation: Palliat Med. 1994;8(3):183-96
references.pmid: 7952369
references.citation: Can Fam Physician. 2000 Jun;46:1301-7
references.pmid: 10907569
references.citation: Support Care Cancer. 2001 Oct;9(7):474-6
references.pmid: 11680828
references.citation: Support Care Cancer. 2004 May;12(5):285-92
references.pmid: 15045573
references.citation: Ann Oncol. 1999 Feb;10(2):135-6
references.pmid: 10093679
references.citation: BMJ. 1990 Jan 20;300(6718):159-61
references.pmid: 2105794
references.citation: Eur J Cancer Care (Engl). 2000 Sep;9(3):138-43
references.pmid: 11881722