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Factors that influence physicians in providing palliative care in rural communities in Taiwan

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Abstract

Goals of work

To identify the willingness, influencing factors, and educational needs of community physicians in providing palliative care in the rural areas of Taiwan.

Methods

A questionnaire was sent to all medical directors of the 140 government health stations assigned to the rural areas of Taiwan.

Results

The overall response rate was 62.8% with 85 valid questionnaires retrieved. The majority of respondents (84.7%) expressed a willingness to provide palliative care if they encountered an advanced cancer patient. However, they would limit their services to consultation and referral (93.0% and 87.5%, respectively), and were less likely to provide home visits (40.3%) or bereavement support of the family (29.2%). With respect to knowledge, the accurate answers to the philosophy/principles and clinical practice of palliative care were 93.4% and 57.3%, respectively. Regarding attitudes, the highest score item in perceiving the threat about providing palliative care was “uncomfortable to meet and take care of the advanced cancer patient.” The highest score item in perceiving barriers was “providing palliative care may shorten patient’s life, just like euthanasia.” The results of stepwise logistic regression analysis for the willingness to provide home visits showed that only the subjective norms remained in the model (OR=1.87, 95% CI=1.17–3.01). Educational needs expressed by the respondents were ranked as follows: emotional support to, communication skills with, and bereavement support for the advanced cancer patients and their relatives.

Conclusions

Effective training courses that emphasize the practical knowledge of palliative care for community physicians, incorporating palliative care into medical education particularly in terms of communication skills and ethical roles, and active health policy administration including insurance payments, are important for the enhancement of community palliative care in Taiwan.

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Acknowledgements

This study was supported by the National Science Council of Taiwan. The authors are grateful to the 85 medical directors of the governmental health stations for their participation. We also acknowledge Ms. K.H. Chao, C.W. Liu, and Y.C. Chen for their assistance in preparing the manuscript.

Author information

Authors and Affiliations

  1. Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, No. 7, Chung-Shan South Rd, Taipei, Taiwan

    Wen-Jing Liu, Tai-Yuan Chiu, Bee-Hong Lue & Ching-Yu Chen

  2. School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan

    Wen-Yu Hu

  3. Chiu’s Family Practice Center, Tainan, Taiwan

    Yie-Fong Chiu

  4. Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Tai-Yuan Chiu & Susumn Wakai

Authors
  1. Wen-Jing Liu
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  2. Wen-Yu Hu
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  3. Yie-Fong Chiu
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  4. Tai-Yuan Chiu
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  5. Bee-Hong Lue
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Corresponding author

Correspondence to Tai-Yuan Chiu.

Appendices

Appendix A

  1. 1.

    Pain and other physical symptoms in advanced cancer patients can be mostly controlled by good palliative care.

  2. 2.

    The goal of palliative care is to achieve the best possible quality of life for the patients and the families, not to cure.

  3. 3.

    Palliative care is respect natural death, not to shorten the life of patients.

  4. 4.

    Psychological, social, and spiritual problems are paramount to the palliative care team who give appropriate consultation and management.

  5. 5.

    Allocation of community resources for patients and families is also the content of palliative care.

  6. 6.

    Palliative care is a work of interdisciplinary fields.

  7. 7.

    It is not the content of palliative care to provide the family care for advanced cancer patients.

  8. 8.

    The palliative care team provides bereavement support for the family after the patient’s death.

  9. 9.

    It is the content of palliative care to help patients face and prepare for death.

  10. 10.

    Palliative care respects for the autonomy and individualized needs of patients.

  11. 11.

    Palliative care provides spiritual care for advanced cancer patients.

  12. 12.

    The staff of the palliative care unit are required to receive adequate palliative care professional training.

  13. 13.

    Palliative care is an alternative for advanced cancer patients.

  14. 14.

    Suffering and physical pain are synonymous.

  15. 15.

    The palliative care team actively controls the pain and other physical symptoms of advanced cancer patients.

  16. 16.

    Palliative care services in Taiwan include inpatient care and home care.

  17. 17.

    The cost of palliative care services in Taiwan has been included in the National Health Care Insurance System.

  18. 18.

    Adjuvant therapies are important in managing pain.

  19. 19.

    Drug addiction is a major problem when morphine is used on a long-term basis for the management of pain.

  20. 20.

    Individuals who are taking morphine should also follow a bowel regimen.

  21. 21.

    The provision of palliative care requires emotional detachment.

  22. 22.

    During the terminal stages of an illness, drugs that can cause respiratory depression are appropriate for the treatment of severe dyspnea.

  23. 23.

    Men generally reconcile their grief more quickly than women.

  24. 24.

    The use of placebos is appropriate in the treatment of some types of pain.

  25. 25.

    Demerol is not an effective analgesic for the control of chronic pain.

  26. 26.

    Manifestations of chronic pain are different from those of acute pain.

  27. 27.

    The loss of a distant or contentious relationship is easier to resolve than the loss of one that is close or intimate.

  28. 28.

    Pain threshold is lowered by fatigue or anxiety.

Appendix B

Circle the number that represents your OPINION (there are no right or wrong answers)

5=strongly agree, 4=agree, 3=uncertain, 2=disagree, 1=strongly disagree:

Perception of the threats from the worsening conditions of advanced cancer patients is:

  1. 1.

    Uncomfortable to take care of advanced cancer patients

  2. 2.

    Influence normal medical activities

  3. 3.

    Hopeless for the cure

  4. 4.

    Unable to easily face dying process and distress

  5. 5.

    Makes me think about death

  6. 6.

    Makes me feel weakness

Perceptions of the benefits for the promotion of life quality is:

  1. 7.

    Able to promote life quality and keep the dignity

  2. 8.

    Able to die peacefully and have good death

  3. 9.

    Having care and accompanied by medical team

  4. 10.

    Relief pain and other symptoms

  5. 11.

    Emotional support

  6. 12.

    Able to have family support

  7. 13.

    Help to have good death

Perceptions of the benefits for better death preparation is:

  1. 14.

    Respect for patient’s religion and burial rites

  2. 15.

    Help to die at home

  3. 16.

    Better communication with advanced cancer patients

  4. 17.

    Help medical staff to take care of patients better

  5. 18.

    Avoid the idea of euthanasia

Perception of the barriers to provide palliative care is:

  1. 19.

    Shorten patient’s, life just like euthanasia

  2. 20.

    No active treatment and only awaits death

  3. 21.

    No aggressive treatment for physical symptoms

  4. 22.

    Give up patients

  5. 23.

    Make patients feel hopeless

  6. 24.

    Patients feel abandoned

  7. 25.

    Advanced cancer patients have many difficult symptoms

  8. 26.

    Make me feel weak to the life

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Liu, WJ., Hu, WY., Chiu, YF. et al. Factors that influence physicians in providing palliative care in rural communities in Taiwan. Support Care Cancer 13, 781–789 (2005). https://doi.org/10.1007/s00520-005-0778-7

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