title: Improvements in Physicians' Knowledge, Difficulties, and Self-Reported Practice After a Regional Palliative Care Program.
abstract: BACKGROUND
  Although several studies have explored the effects of regional palliative care programs, no studies have investigated the changes in physician-related outcomes.
  
  
  OBJECTIVE
  The primary aims of this study were to: (1) clarify the changes in knowledge, difficulties, and self-reported practice of physicians before and after the intervention, (2) explore the potential associations between the level of physicians' participation in the program and outcomes, and (3) identify the reasons and characteristics of physicians who did not participate in the program.
  
  
  METHODS
  As a part of the regional palliative care intervention trial, questionnaires were sent to physicians recruited consecutively to obtain a representative sample of each region. Physician-reported knowledge, difficulty of palliative care, and self-perceived practice were measured using the Palliative Care Knowledge Test, Palliative Care Difficulty Scale, and Palliative Care Self-Reported Practice Scale (PCPS), respectively. The level of their involvement in the program and reason for non-participation were ascertained from self-reported questionnaires.
  
  
  RESULTS
  The number of eligible physicians identified was 1870 in pre-intervention and 1763 in post-intervention surveys, and we obtained 911 and 706 responses. Total scores of the Palliative Care Knowledge Test, PCPS, and PCPS were significantly improved after the intervention, with effect sizes of 0.30, 0.52, and 0.17, respectively. Physicians who participated in workshops more frequently were significantly more likely to have better knowledge, less difficulties, and better self-reported practice.
  
  
  CONCLUSIONS
  After the regional palliative care program, there were marked improvements in physicians' knowledge and difficulties. These improvements were associated with the level of physicians' participation in the program.
authors.affiliation: Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. Electronic address: kizawa-ysyk@umin.org.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
authors.affiliation: Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.affiliation: Shinjo Clinic, Kobe, Hyogo, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Shinjo
authors.affiliation: Department of Community Health Care, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Akemi
authors.initials: A
authors.lastname: Yamagishi
authors.affiliation: Department of Surgery, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital, East, Kashiwa, Chiba, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Shirahige Clinic, Nagasaki, Nagasaki, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shirahige
authors.affiliation: Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Division of Medical Oncology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000328:Adult; D004501:Education, Medical / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000379:methods; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D057566:Self Report
keywords: Physician; difficulty; knowledge; palliative care; regional palliative care