A Japanese region-wide survey of the knowledge, difficulties and self-reported palliative care practices among nurses

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 (fivepoint 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.