Background: In Japan, a nation-wide education program for primary palliative care (the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education: PEACE) was established in 2008. In 2018, this program was revised from a two-day workshop to a hybrid program combining e-learning with a one-day workshop. This study aimed to assess the changes in participant knowledge and difficulties after having completed the revised education program. Methods: The subjects of this study were all participants who completed the revised program from April 2018 to March 2019. We conducted a pre-post survey via the e-learning system, and measured scores on the palliative care knowledge questionnaire to evaluate PEACE (PEACE-Q) and Palliative Care Difficulties Scale (PCDS). Results: A total of 11,124 participants completed the revised program from June 2018 to March 2019. Participants’ knowledge improved significantly according to the PEACE-Q with a total score of 24.1 and 30.0 (p<0.0001), and difficulties diminished as indicated by the PCDS with a total score of 45.2 and 39.2 (p<0.0001). Participants in different professions obtained similar results. Conclusion: Participants’ knowledge and difficulties improved after the revised nationwide primary palliative care education program. Similar results were obtained by participants in different professions.

Objective: This study aimed to reveal the prevalence and characteristics of anguish among delirious patients with advanced cancer receiving specialized palliative care services. Methods: We conducted a subanalysis of a multicenter, prospective, observational study at 14 inpatient palliative care units and 10 general wards that offered psycho-oncology consultation service in Japan. We consecutively enrolled the patients with advanced cancer who were diagnosed with delirium and prescribed antipsychotics. Palliative care specialists decided whether patients suffered from anguish or not. We assessed patients’ background and severity of delirium with the Delirium Rating Scale-Revised (DRS-R-98). Results: Of 818 enrolled patients, 99 (12.1%) suffered from anguish. We observed a significant difference in the mean age (68.9±12.6 vs. 72.1±11.2, p=0.009), prevalence of dementia (2% vs. 10.4%, p=0.005) between patients with anguish and those without anguish. Patients with anguish had lower DRS-R-98 total scores before medication than those without anguish (15.3±8.1 vs. 17.3±7.8, p=0.018), but higher severity score in lability of affect (1.2±0.8 vs 1.0±0.9, p=0.023). Conclusions: The results of this study suggested that patients with anguish tend to be younger, mostly do not have dementia, and have lower delirium severity score but higher score in lability of affect. Nevertheless, further research, investigating appropriate evaluations and medical interventions for patients with anguish is warranted.