title: Barriers to providing palliative care and priorities for future actions to advance palliative care in Japan: a nationwide expert opinion survey.
abstract: OBJECTIVE
  Palliative care specialists are faced with extensive barriers to providing effective palliative care. We carried out a survey to identify existing barriers from the point of view of palliative care experts in Japan and determine the priorities for future actions to overcome these barriers.
  
  
  METHODS
  We conducted a cross-sectional mail survey in December 2004. We sent out 2607 questionnaires to members of the Japanese Society of Palliative Medicine and Hospice Palliative Care Japan. We asked all respondents two open-ended questions regarding barriers and future actions in the context of palliative care in Japan. In total, 426 questionnaires were returned (response rate of 16%).
  
  
  RESULTS
  We identified 95 different answers concerning barriers to providing effective palliative care. The three most frequent answers were "general medical practitioners' lack of interest, knowledge, and skills" (n = 203), "general population's lack of knowledge and misunderstandings about palliative care" (n = 122), and "general medical practitioners' failure to provide information and lack of communication skills" (n = 89). We identified 136 different answers concerning future actions required to improve palliative care. The three most frequent answers were "organize study sessions on palliative care or case conferences in hospitals" (n = 122), "provide information about palliative care to the general population" (n = 117), and "in undergraduate education, make palliative care a compulsory course" (n = 88).
  
  
  CONCLUSIONS
  We identified numerous barriers to providing effective palliative care, related to not only medical practitioners, but also economic factors and the general population. These findings suggest that to overcome these barriers, we need to take action on many fronts, including increasing social awareness and effecting political change, as well as addressing problems relating to practitioners. We prioritized the future actions. The most frequent urgent problems were identified. We hope that collaborative efforts by the relevant organizations will improve palliative care in Japan.
authors.affiliation: Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. miyasita-tky@umin.net
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Makiko
authors.initials: M
authors.lastname: Sanjo
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Kei
authors.initials: K
authors.lastname: Hirai
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Shima
authors.forename: Naohito
authors.initials: N
authors.lastname: Shimoyama
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuneto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Hiraga
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Uchitomi
mesh_terms: D001291:Attitude of Health Personnel / Q000208:ethnology; D001293:Attitude to Death / Q000208:ethnology; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006292:Health Priorities; D017051:Hospice Care / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D007564:Japan; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011788:Quality of Life; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D012962:Sociology, Medical; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*