Palliative Care Emphasis Program on Symptom Management and Assessment for Continuous Medical Education (PEACE) Project

From APHN Editorial Team (Japan)— Hospice Palliative Care Japan

Written by: Prof Yosuyuki KIZAWA, APHN Council, Designated Professor, Department of Palliative Medicine, Kobe University Graduate School of Medicine

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Palliative care is an essential part of medicine, but most physicians have had no formal opportunity to acquire basic skills in palliative care. In Japan, the Palliative Care Emphasis Program on Symptom Management and Assessment for Continuous Medical Education (PEACE) was launched in 2008 to provide nation-wide formal primary palliative care education for all physicians engaged in cancer care. This project aimed to raise competence of physicians in palliative care practice.

As of Sep. 2015, the total number of physicians who participated and completed the PEACE program was 63,528. This number shows that approximately 20 percent of physicians in Japan have completed the education program, making this program one of the largest palliative care education project in the world.

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PEACE is a 2-day program with 9 basic modules which touches on topics such as the concept of palliative care and assessment and management of cancer pain. The program comprises of 2 12-hour interactive workshops that combine didactic plenary sessions, role-play sessions, and small group discussions. 6 additional modules for End-of-Life (EOL) care were also provided for the participants who engaged in EOL care.

The program focuses not only on basic palliative care but also on the integration of palliative care and psycho-oncology such as solving patient misunderstandings about opioids, reducing the difficulty in breaking bad news to patients, cultivating an appropriate manner for listening to and sympathizing with the patient, and formulating a care plan among an interdisciplinary team.

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The PEACE project improve physicians’ knowledge of, practice in, and difficulties with palliative care. Among the 223 physicians who participated in the program, 85 (38%) answered the follow-up survey. Significant improvements were noted on the PEACE-Q (Knowledge scale validated for the program published in JPM 2013) compared with baseline scores immediately after completion of the program, and this progress was maintained 2 months later (21.7±5.56 versus 29.5±2.10 versus 28.7±3.28, respectively; p < 0.0001). Similarly, significant improvements were noted for total scores on both the Palliative Care Practice Scale (PCPS) and the Palliative Care Difficulty Scale (PCDS) at 2 months after completion of the program(Yamamoto R, J Palliat Med 2015.)

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As a result of this education project, palliative care has been recognized as one of core competencies for all doctors especially in oncology, and this has facilitated the integration of palliative care in oncology practice.