title: Regional medical professionals' confidence in providing palliative care, associated difficulties and availability of specialized palliative care services in Japan.
abstract: BACKGROUND
  Although confidence in providing palliative care services is an essential component of providing such care, factors relating to this have not been investigated in Japan.
  
  
  OBJECTIVE
  This study aimed to explore confidence in the ability to provide palliative care and associated difficulties and to explore correlations between these variables. Design A cross-sectional mail survey of medical doctors and registered nurses in Japan was performed as part of a regional intervention trial: the Outreach Palliative Care Trial of Integrated Regional Model study. Subjects Questionnaires were sent to 7905 medical professionals, and 409 hospital doctors, 235 general practitioners, 2160 hospital nurses and 115 home visiting nurses completed them.
  
  
  RESULTS
  Confidence in providing palliative care was low and difficulties frequent for all types of medical professionals assessed. In particular, only 8-24% of them, depending on category, agreed to 'having adequate knowledge and skills regarding cancer pain management'. In particular, 55-80% of medical professionals acknowledged difficulty with 'alleviation of cancer pain'. Multiple regression analysis revealed that confidence was positively correlated with the amount of relevant experience and, for medical doctors, with 'prescriptions of opioids (per year)'. Moreover, difficulties were negatively correlated with the amount of relevant clinical experience.
  
  
  CONCLUSIONS
  Effective strategies for developing regional palliative care programs include basic education of medical professionals on management of cancer-related pain (especially regarding opioids) and other symptoms.
authors.affiliation: *Department of System Management in Nursing, Graduate School of Heath Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan. hirkanr@tmd.ac.jp.
authors.forename: Kayo
authors.initials: K
authors.lastname: Hirooka
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Saran
authors.initials: S
authors.lastname: Yoshida
authors.forename: Nobuya
authors.initials: N
authors.lastname: Akizuki
authors.forename: Miki
authors.initials: M
authors.lastname: Akiyama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shirahige
authors.forename: Kenji
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006699:Home Care Services / Q000592:standards; D006801:Humans; D007564:Japan; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D009726:Nurses / Q000523:psychology / Q000706:statistics & numerical data*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods / Q000592:standards; D010166:Palliative Care / Q000379:methods / Q000592:standards; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid
keywords: confidence; difficulties; medical professionals; palliative care