title: The effects of community-wide dissemination of information on perceptions of palliative care, knowledge about opioids, and sense of security among cancer patients, their families, and the general public.
abstract: OBJECTIVE
  Prejudices against palliative care are a potential barrier to quality end-of-life care. There have been few large-scale community-wide interventions to distribute appropriate information about palliative care, and no studies have investigated their impact on cancer patients, their families, and the general public. Thus, we conducted a 3-year community intervention and evaluated the effects of distributing such information at the community level, and explored associations among levels of exposure, perceptions, knowledge, and the sense of security achieved.
  
  
  METHODS
  Over a period of 3 years, we provided flyers, booklets, posters, and public lectures about palliative care in four regions of Japan, and carried out pre- and post-intervention surveys with repeated cross-sectional samplings of cancer patients (pre 859, post 857), bereaved family members (1110, 1137), and the general public (3984, 1435). The levels of exposure to the provided information were measured by a multiple-choice questionnaire after intervention. Multiple logistic regression analyses were used to estimate multivariable-adjusted odds ratios (ORs) for perceptions of palliative care, knowledge about opioids, and sense of security among the exposure groups.
  
  
  RESULTS
  Overall perceptions of palliative care, opioids, and receiving care at home improved significantly among the general public and families, but not among the patients at the community level. However, multiple regression revealed that patients of extensive exposure category had significantly more positive perceptions of palliative care to those of non-exposure category (p = 0.02). The sense of security regarding cancer care of all patients, family members, and the general public improved. Among others, the respondents who reported extensive exposure in the general public and family members scored significantly higher sense of security.
  
  
  CONCLUSIONS
  Our findings indicate that providing palliative care information via small media and lectures in the community is effective in improving perceptions of palliative care and knowledge about opioids among the community dwellers, especially for caregivers of the patients. The acquisition of adequate knowledge about palliative care from various information sources may improve people's sense of security regarding cancer.
authors.affiliation: Faculty of Environment and Information Studies, Keio University, 2355 Endo, Fujisawa, Kanagawa, 252-0882, Japan. miki@sfc.keio.ac.jp.
authors.forename: Miki
authors.initials: M
authors.lastname: Akiyama
authors.affiliation: Center for the Study of Communication Design, Psychology and Behavioral Sciences, Graduate School of Human Sciences, Osaka University, Osaka, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Hirai
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Takebayashi
authors.affiliation: Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department 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: Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Ayano
authors.initials: A
authors.lastname: Takeuchi
authors.affiliation: Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
authors.forename: Akemi
authors.initials: A
authors.lastname: Yamagishi
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, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shirahige
authors.affiliation: Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Eguchi
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007564:Japan; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D010465:Perception; D011639:Public Opinion; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology / Q000592:standards*
chemical_list: D000701:Analgesics, Opioid
keywords: Community intervention; Opioid; Palliative care; Perception; Sense of security