title: Relationships between family physicians' referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: a survey of rural and urban family physicians.
abstract: BACKGROUND
  The primary objective of this research was to assess the relationship between FPs' knowledge of palliative radiotherapy (RT) and referral for palliative RT.
  
  
  METHODS
  1001 surveys were sent to FPs who work in urban, suburban, and rural practices. Respondents were tested on their knowledge of palliative radiotherapy effectiveness and asked to report their self-assessed knowledge.
  
  
  RESULTS
  The response rate was 33%. FPs mean score testing their knowledge of palliative radiotherapy effectiveness was 68% (SD = 26%). The majority of FPs correctly identified that painful bone metastases (91%), airway obstruction (77%), painful local disease (85%), brain metastases (76%) and spinal cord compression (79%) can be effectively treated with RT, though few were aware that hemoptysis (42%) and hematuria (31%) can be effectively treated. There was a linear relationship between increasing involvement in palliative care and both self-assessed (p < 0.001) and tested (p = 0.02) knowledge. FPs had higher mean knowledge scores if they received post-MD training in palliative care (12% higher; p < 0.001) or radiotherapy (15% higher; p = 0.002). There was a strong relationship between FPs referral for palliative radiotherapy and both self-assessed knowledge (p < 0.001) and tested knowledge (p = 0.01).
  
  
  CONCLUSIONS
  Self-assessed and tested knowledge of palliative RT is positively associated with referral for palliative RT. Since palliative RT is underutilized, further research is needed to assess whether family physician educational interventions improve palliative RT referrals. The current study suggests that studies could target family physicians already in practice, with educational interventions focusing on hemostatic and other less commonly known indications for palliative RT.
authors.affiliation: Department of Radiation Therapy, BC Cancer Agency, Vancouver Centre, Vancouver, Canada. rolson2@bccancer.bc.ca
authors.forename: Robert A
authors.initials: RA
authors.lastname: Olson
authors.forename: Sonca
authors.initials: S
authors.lastname: Lengoc
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
authors.forename: John
authors.initials: J
authors.lastname: French
authors.forename: Colleen
authors.initials: C
authors.lastname: McGahan
authors.forename: Jenny
authors.initials: J
authors.lastname: Soo
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education*; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D010166:Palliative Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018787:Radiation Oncology / Q000193:education*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires