{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:36:04Z","timestamp":1791459364226,"version":"4.3.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To explore palliative care difficulties perceived by physicians in nonspecialist hospitals and identify consultation needs, focusing on their association with physicians\u2019 backgrounds and hospital characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Subjects:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Physicians\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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\u201312.0), with a significant difference by number of cancer patients treated annually (&lt;10 patients: 10.0 vs. &gt;50 patients: 8.4, difference \u22121.6, 95%CI: \u22122.4, \u22120.8). Physicians in communities with emergency admission facilities reported fewer difficulties. Unfamiliar medications (57.7%\u201360.2%) and advice on medication choice (53.4%\u201360.1%) presented the most consultation needs. Physicians in hospitals with &lt;50 cancer deaths annually had significant consultation needs for nerve blocks (OR 1.57, 95%CI: 1.05\u20132.35) and radiation therapy (OR 2.47, 95%CI: 1.62\u20133.82) for symptom relief.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Difficulties and consultation needs varied by physician and hospital factors. Targeted support may enhance palliative care delivery in nonspecialist hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jpm.2025.0105","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T18:55:57Z","timestamp":1748372157000},"page":"1220-1229","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Physicians\u2019 Difficulties and Consultation Needs in Hospitals Without Palliative Care Specialists"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3658-4514","authenticated-orcid":false,"given":"Yoko","family":"Nakazawa","sequence":"first","affiliation":[{"name":"Division of Policy Evaluation, Institute for Cancer Control, National Cancer Center, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richi","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Division of Policy Evaluation, Institute for Cancer Control, National Cancer Center, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Ishimaru","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Akashi Medical Center, Akashi, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0304-9881","authenticated-orcid":false,"given":"Jun","family":"Hamano","sequence":"additional","affiliation":[{"name":"Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Kizawa","sequence":"additional","affiliation":[{"name":"Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"e_1_3_6_2_2","unstructured":"International Agency for Research on Cancer. 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