title: A Japanese region-wide survey of the knowledge, difficulties and self-reported palliative care practices among nurses.
abstract: OBJECTIVE
  We investigated palliative care knowledge, difficulty and self-reported practice among a region-wide sample of nurses who cared for cancer patients in Japan.
  
  
  METHODS
  A cross-sectional questionnaire survey was distributed to 9 designated cancer centers, 17 community hospitals and 73 district nurse services across 4 regions in 2008. We used the Palliative Care Knowledge Test, the Palliative Care Difficulty Scale (five-point Likert scale) and the Palliative Care Self-Reported Practices Scale (five-point Likert scale).
  
  
  RESULTS
  In total, 2378 out of 3008 nurses (79%) responded. The knowledge, difficulty and self-reported practice scores were 51 ± 20%, 3.2 ± 0.7 and 3.7 ± 0.6, respectively. In the knowledge test, philosophy scored highest (88 ± 26%) and psychiatric problems scored lowest (37 ± 29%). In the difficulty test, alleviating symptoms scored most difficult (3.5 ± 0.8) and providing expert support scored least difficult (2.9 ± 1.3). In the self-reported practice questionnaire, pain and delirium relief were most frequently (4.0 ± 0.8) and least frequently (3.1 ± 0.9) provided, respectively. Knowledge was significantly poorer in community hospitals (P = 0.035); difficulty scores were significantly higher in community hospitals (P < 0.001) and district nurse services (P = 0.013); and self-reported practice scores were significantly poorer in community hospitals (P < 0.001) but superior in district nurse services (P < 0.001) than in designated cancer centers.
  
  
  CONCLUSIONS
  Knowledge, difficulty and self-reported practice for symptom management, particularly psychological symptoms, were insufficient, particularly in community hospitals. Education, expert support and adequate clinical experiences would help provide quality palliative care.
authors.affiliation: Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi kazukisato@med.tohoku.ac.jp.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Palliative Care Partners, Tokyo.
authors.forename: Megumi
authors.initials: M
authors.lastname: Umeda
authors.affiliation: Department of Nursing, Faculty of Medical Sciences, Teikyo University of Science, Tokyo.
authors.forename: Ichie
authors.initials: I
authors.lastname: Ishigamori
authors.affiliation: Department of Adult Health Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Igarashi
authors.affiliation: Department of Discharge Planning and Community Coordination, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata.
authors.forename: Sei
authors.initials: S
authors.lastname: Togashi
authors.affiliation: Department of Psycho-Oncology, National Cancer Center Hospital, East Kashiwa, Chiba.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Harada
authors.affiliation: Department of Psycho-Oncology, National Cancer Center Hospital, East Kashiwa, Chiba.
authors.forename: Masako
authors.initials: M
authors.lastname: Miyashita
authors.affiliation: Palliative Care Team, Division of Nursing, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Sakuma
authors.affiliation: Palliative Care Team, Division of Nursing, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka.
authors.forename: Junko
authors.initials: J
authors.lastname: Oki
authors.affiliation: Consortium for Home Health Care in Nagasaki, University of Nagasaki, Nagasaki, Japan.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Yoshihara
authors.affiliation: Division of Medical Oncology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000328:Adult; D002173:Cancer Care Facilities; D003430:Cross-Sectional Studies; D003693:Delirium / Q000451:nursing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006764:Hospitals, Community; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009726:Nurses / Q000523:psychology* / Q000706:statistics & numerical data*; D009738:Nursing Service, Hospital; D059408:Pain Management / Q000451:nursing; D010166:Palliative Care; D057566:Self Report; D011795:Surveys and Questionnaires; D019452:Terminally Ill
keywords: attitude; health knowledge; neoplasm; nurse; palliative care; practice; terminal care