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