Oregon hospice nurses and social workers' assessment of physician progress in palliative care over the past 5 years

Background: The 1997 enactment of the Oregon Death with Dignity Act intensified interest in improving physician education and skills in caring for patients at the end of life. Objective: To obtain hospice nurse and social workers' collateral ratings of efforts made by Oregon physicians to improve their palliative care skills over the previous 5 years. Design: A descriptive survey of nurses and social workers from all 50 Oregon outpatient hospice agencies. Measurement and Results: Oregon hospice nurse (N = 185) and social worker (N = 52) respondents, who had worked in hospice for at least 5 years, rated changes they observed over the past 5 years in physicians' approach to caring for their hospice clients. Six characteristics, including willingness to refer patients to hospice, willingness to prescribe sufficient pain medications, knowledge about using pain medications in hospice patients, interest in caring for hospice patients, competence in caring for hospice patients, and fearfulness of prescribing sufficient opioid medications were evaluated. Positive changes were endorsed by the majority of respondents on all but the scale measuring fearfulness of prescribing opioid medications; on the latter, 47% of nurses rated doctors as less fearful, whereas 53% rated them as about the same or more fearful than they were 5 years earlier. Conclusions: Most respondents rated Oregon physicians as showing improvements in knowledge and willingness to refer and care for hospice patients.