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 advance d and incurable stages of cancer. More than 70% of all cancer patients in I ndia require palliative care for relief of pain, other symptoms and psychos ocial distress. The need for education and training in palliative care has been emphasized by the World Health Organization (WHO) during the past 15 y ears. This survey aimed to assess the awareness, clinical knowledge, and ed ucation and training aspects of palliative care among the clinical resident s of a tertiary care hospital. Methods. During January and February 1999, a total of 100 residents were as ked to respond to a questionnaire on palliative care education and training during residency. The questionnaire consisted of 10 questions (each questi on with 3 different responses). Awareness regarding palliative care was ass essed by 3 questions; clinical knowledge by 4 questions; and education and training obtained during residency by 3 questions, Comparisons were made us ing the Chi-square test between the oncology and non-oncology resident grou ps. Results Forty-nine residents (23 oncology and 26 nononcology) responded to the survey. Awareness that palliative care involves active total care was l acking in 8 (16%) residents. The cost of palliative care in India was consi dered high by 17 (65%) non-oncology residents and 21 (43%) of the whole gro up. 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 gro up, 21 (43%) believed that palliative care could be provided on an outpatie nt basis. Pain, depression and cachexia were identified as the most distres sing symptoms of patients with incurable cancer. Seventeen (83%) oncology a nd 4 (15%) non-oncology residents (p=0.000) knew how to use the WHO step-la dder for cancer pain relief. All oncology residents and 10 (38%) non-oncolo gy residents preferred the oral route for providing medications for pain re lief (p=0.0001). The didactic education and training imparted during reside ncy was considered as 'not enough' by 39% of oncology and 62% of non-oncolo gy residents (51% overall). The confidence to deliver quality palliative ca re was lacking in 43% and 58% of oncology and non-oncology residents, respe ctively. Conclusion, Clinicians in India need to be provided focused skills and trai ning for them to be able deliver quality palliative care to the large numbe r of patients with incurable cancer. The cost of palliative care and the op timum place to deliver it, the symptoms of advanced cancer, pain relief and symptom control methods and quality of life in end-stage cancer patients a re some aspects that should be an integral part of clinical residency progr ammes.