title: Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians.
abstract: BACKGROUND
  The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process.The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group.The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper.
  
  
  METHODS
  Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education.
  
  
  RESULTS
  169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI 95%: 2.8 to 6.5 (p = 0.0001), scale range 0-33), confidence in symptom management (p = 0.02) and confidence in terms of communication (p = 0.038). Useful aspects were pointed out, as well as others to be improved in future applications. The satisfaction of the intervention group was high.
  
  
  CONCLUSIONS
  The results of this study show that there was a significant increase of knowledge of 14%-20% and a significant increase in the perception of confidence in symptom management and communication in the intervention group in comparison with the control group that received traditional methods of education in palliative care or no educational activity at all. The overall satisfaction with the intervention was good-very good for most participants.This on-line educational model seems a useful tool for palliative care training in primary care physicians who have a high opinion about the integration of palliative care within primary care. The results of this study support the suggestion that learning effectiveness should be currently investigated comparing different Internet interventions, instead of Internet vs. no intervention.
authors: Primary care, NHS, Valencia, Spain. mpelayo@ribera10.com
authors: Marta
authors: M
authors: Pelayo
authors: Diego
authors: D
authors: Cebrián
authors: Almudena
authors: A
authors: Areosa
authors: Yolanda
authors: Y
authors: Agra
authors: Juan Vicente
authors: JV
authors: Izquierdo
authors: Félix
authors: F
authors: Buendía
references: J Cancer Educ. 2010 Sep;25(3):317-23
references: 20119693
references: Acad Med. 2006 Oct;81(10 Suppl):S30-4
references: 17001130
references: Aten Primaria. 1999 Mar 15;23(4):187-91
references: 10333601
references: JAMA. 2005 Sep 7;294(9):1043-51
references: 16145024
references: Palliat Med. 2007 Oct;21(7):609-14
references: 17942499
references: Acad Med. 2002 Oct;77(10 Suppl):S86-93
references: 12377715
references: J Contin Educ Health Prof. 2002 Fall;22(4):214-21
references: 12613056
references: Chest. 2000 Aug;118(2 Suppl):18S-23S
references: 10939995
references: Chest. 1999 May;115(5):1429-36
references: 10334164
references: J Cancer Educ. 2010 Jun;25(2):224-8
references: 20204577
references: BMC Med Inform Decis Mak. 2007 Sep 14;7:26
references: 17854509
references: J Pain Symptom Manage. 2000 Sep;20(3):202-9
references: 11018338
references: CMAJ. 2010 Mar 23;182(5):E216-25
references: 20212028
references: BMC Med. 2008 Dec 04;6:37
references: 19055789
references: J Contin Educ Health Prof. 2004 Spring;24(2):68-75
references: 15279131
references: Am J Med Qual. 2008 Nov-Dec;23(6):475-83
references: 19001103
references: BMC Palliat Care. 2008 Apr 30;7:4
references: 18447916
references: Palliat Med. 2001 May;15(3):191-6
references: 11407190
references: Aust J Rural Health. 2007 Dec;15(6):389
references: 17970904
references: Med Educ. 2005 Jun;39(6):561-7
references: 15910431
references: Palliat Med. 2006 Oct;20(7):673-83
references: 17060266
references: Acad Med. 2005 Mar;80(3):266-78
references: 15734809
references: J Contin Educ Health Prof. 2004 Winter;24(1):20-30
references: 15069909
references: JAMA. 2008 Sep 10;300(10):1181-96
references: 18780847
references: J Pain Symptom Manage. 2002 May;23(5):383-92
references: 12007756
references: J Am Med Inform Assoc. 2008 May-Jun;15(3):374-82
references: 18308992
references: Support Care Cancer. 2000 Nov;8(6):464-71
references: 11094991
references: J Palliat Care. 2001 Spring;17(1):41-5
references: 11324184
references: J Cancer Educ. 2010 Sep;25(3):418-21
references: 20237885
references: J Cancer Educ. 1999 Fall;14(3):161-3
references: 10512333