Palliative care education and training during residency: a survey among residents at a tertiary care hospital.

BACKGROUND: Palliative care is the active total care of patients in advanced and incurable stages of cancer. More than 70% of all cancer patients in India require palliative care for relief of pain, other symptoms and psychosocial distress. The need for education and training in palliative care has been emphasized by the World Health Organization (WHO) during the past 15 years. This survey aimed to assess the awareness, clinical knowledge, and education and training aspects of palliative care among the clinical residents of a tertiary care hospital. METHODS: During January and February 1999, a total of 100 residents were asked to respond to a questionnaire on palliative care education and training during residency. The questionnaire consisted of 10 questions (each question with 3 different responses). Awareness regarding palliative care was assessed by 3 questions; clinical knowledge by 4 questions; and education and training obtained during residency by 3 questions. Comparisons were made using the Chi-square test between the oncology and non-oncology resident groups. RESULTS: Forty-nine residents (23 oncology and 26 non-oncology) responded to the survey. Awareness that palliative care involves active total care was lacking in 8 (16%) residents. The cost of palliative care in India was considered high by 17 (65%) non-oncology residents and 21 (43%) of the whole group. Hospice, as the right place for palliative care, was chosen by 14 (61%) oncology and 3 (11.5%) non-oncology residents (p = 0.0003). In the whole group, 21 (43%) believed that palliative care could be provided on an outpatient basis. Pain, depression and cachexia were identified as the most distressing symptoms of patients with incurable cancer. Seventeen (83%) oncology and 4 (15%) non-oncology residents (p = 0.000) knew how to use the WHO step-ladder for cancer pain relief. All oncology residents and 10 (38%) non-oncology residents preferred the oral route for providing medications for pain relief (p = 0.0001). The didactic education and training imparted during residency was considered as 'not enough' by 39% of oncology and 62% of non-oncology residents (51% overall). The confidence to deliver quality palliative care was lacking in 43% and 58% of oncology and non-oncology residents, respectively. CONCLUSION: Clinicians in India need to be provided focused skills and training for them to be able deliver quality palliative care to the large number of patients with incurable cancer. The cost of palliative care and the optimum place to deliver it, the symptoms of advanced cancer, pain relief and symptom control methods and quality of life in end-stage cancer patients are some aspects that should be an integral part of clinical residency programmes.