Physicians' Difficulties and Consultation Needs in Hospitals Without Palliative Care Specialists

Background: Despite the proven effectiveness of palliative care, approximately half of cancer patients in Japan die in hospitals without palliative care specialists, and the difficulties physicians perceive when providing such care remain unclear. Objectives: To explore palliative care difficulties perceived by physicians in nonspecialist hospitals and identify consultation needs, focusing on their association with physicians' backgrounds and hospital characteristics. Design, Subjects: A nationwide cross-sectional survey of 2160 hospital-based physicians from 126 hospitals and 579 certified primary care physicians in Japan was conducted between December 2023 and January 2024. Measurements: Physicians' palliative care difficulties and consultation needs were assessed. Generalized linear models were employed to identify the factors associated with difficulties. Logistic regression was used to compare consultation needs with hospital cancer mortality. Results: A total of 430 responses were analyzed. The score for difficulties in alleviating symptoms ranged from 8.0 to 10.0 (score range 3.0-12.0), with a significant difference by number of cancer patients treated annually (<10 patients: 10.0 vs. >50 patients: 8.4, difference -1.6, 95%CI: -2.4, -0.8). Physicians in communities with emergency admission facilities reported fewer difficulties. Unfamiliar medications (57.7%-60.2%) and advice on medication choice (53.4%-60.1%) presented the most consultation needs. Physicians in hospitals with <50 cancer deaths annually had significant consultation needs for nerve blocks (OR 1.57, 95%CI: 1.05-2.35) and radiation therapy (OR 2.47, 95%CI: 1.62-3.82) for symptom relief. Conclusions: Difficulties and consultation needs varied by physician and hospital factors. Targeted support may enhance palliative care delivery in nonspecialist hospitals.