it is defined by the world health organization ( who ) as an approach that improves the quality of life of patients and their families facing problems associated with life - threatening illness , through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems , physical , psychosocial , and spiritual . while cancer patients remain the largest group that receives palliative care , it is becoming increasingly recognized that people suffering from chronic , progressive illnesses , which will eventually become terminal require same type of end of life care . in the course of the development of palliative care , one very important declaration was made at a meeting in barcelona in 1995 , when the european association for palliative care declared that every individual had the right to pain relief , and that palliative care must be provided according to the principle of equity , irrespective of race , gender , social status , national origin , or the ability to pay for services . significant progress has been made in some countries especially those with well - developed health systems . however , most countries in the world have a long way to go to improving palliative care for their people . in saudi arabia , the palliative care program , started in the early 1990s at king faisal specialist hospital ( kfshrc ) in riyadh , is thought to be the most developed program in the region , and can be considered a regional center of excellence providing palliative care for the entire region . the objectives of this study : to determine the knowledge of the residents working in king abdul - aziz university hospital ( kaauh ) about palliative care . through a cross - sectional descriptive study , all residents working in all departments in kaauh ( n = 80 ) were personally invited to participate in the study . all responses were to be kept confidential and were not to be disclosed except for study purposes . a self - administered questionnaire was used to collect data from the respondents in june 2010.the first of this two - part questionnaire included variables describing socio - demographic characteristics and educational background . the second was developed by a palliative care education initiative at dalhousie university in canada in 2000 and comprised 25 items on the knowledge of palliative care . all data were verified by hand and were coded and entered into a personal computer . statistical package for the social sciences ( spss ) , version 16 was used for statistical analysis . the answers on the questions reflecting knowledge of the participants on palliative care were scored by giving 1 score for each correct answer . the total scores were tested for normality , and if distribution was normal , an independent t - test was used to compare two subgroups , and analysis of variance ( anova ) test used to compare three or more subgroups . the majority of the respondents were saudis ( 92.3% ) , with nearly equal percentages of males ( 49.2% ) and females ( 50.8% ) . the mean age was 29.1  2.4 years , approximately two - thirds ( 66.2% ) of whom had graduated less than 5 years before the study . the majority ( 70.8% ) were graduates of king abdul - aziz university ( kau ) and endorsed in the residency program . they were either sponsored by the faculty of medicine ( 36.9% ) , kau hospital ( 26.2% ) , or by other faculties ( 36.9% ) . only 29.2% of the respondents indicated that they had received previous didactic teaching on palliative care . the percentage of right answers on palliative care ranged between 0% and 60% with a mean value of 29.9%  9.9% . although one - third of the physicians gave the right answers on the circumstances for increasing the dosage of opioids in colon cancer ( 35.4% ) , a much lower percentage ( 16.9% ) knew the appropriate first line drug treatment for opioid induced nausea , and only 13.8% knew about the likelihood of opioid addiction as a result of cancer pain control . a small proportion ( 13.8% ) of participants knew the first drug of choice for daily prophylaxis for constipation when using opioids , and the probable indication for the use of opioids for the treatment of cancer . a small number of physicians ( 9.2% ) knew the primary reason for increasing the dose of opioids in patients with chronic cancer pain . the level of knowledge was highest in areas concerned with the explanation for increased doses of pain medication for terminal cancer patients , the impact of external beam radiotherapy in pain relief for bone metastasis and the appropriate response to the request of the family not to give the patient the responses of the participants to the items reflecting their knowledge about palliative care there were no significant differences in the mean knowledge score among participants according to their demographic characteristics . moreover , it was found that the reported previous education on palliative care was not associated with significant differences in the mean percentage of right answers between those who had previous training ( 30.4%  9.9% ) and those who had not ( 29.1%  10.2% ) . although residents working in internal medicine departments achieved higher knowledge scores than their colleagues , this difference was not statistically significant with other departments [ table 2 ] . a comparison of achieved percentage of right answers on palliative care among participants in relation to their characteristics although the who cancer unit advocated the use of opioids in the early 1980s as a major intervention for cancer pain relief , our results revealed that the knowledge of our residents regarding opioid use as an important medication in palliative care was generally very low . the overall percentage of right answers recorded from our participants ( 29.9%  9.9% ) was considerably low . a similar level of knowledge on palliative care has been documented for physicians in the usa who care for patients with diminished mental capacity who are critically ill . however , a german study using a different questionnaire , indicated a higher percentage of knowledge in prehospital emergency physicians . there were , on the average , 10.8 ( 43.3% ) questions ( sd  5.7 , range 224 ) answered correctly . this variation could be attributed to the differences in the study design , the assessment tools used or the presence of specialized team with better knowledge in palliative care . physicians lack of knowledge on palliative care was discussed in a study conducted in india . the two reasons given are ( a ) the lack of knowledge about the nature of the end - stage of some clinical cases such as cancer pain and ( b ) the lack of education , which accounts for the meager knowledge about palliative care . our findings revealed that the length of time since graduation had no significant effect on the knowledge scores . these findings are dissimilar from observations made on prehospital emergency physicians in germany , where it was found that physicians with professional experience of less than 5 years answered statistically significantly more questions correctly . the first is that since the introduction of palliative care in the undergraduate curriculum was recent , those whose experience was less than 5 years had this type of didactic teaching , which had not been available to those who had graduated 5 or more years before . the second reason is the claim that palliative care was not sufficiently covered in the continuous medical education program . therefore , it was recommended that more attention should be paid to education on pain therapy and end - of - life care . in a german report , academic training was said to have a positive impact on the knowledge of future physicians about palliative care . however , our findings revealed that there was no significant difference in the knowledge of our physicians according to their history of training . that their previous training was not reflected in the scores of the participants might in fact , be due to the small sample size or inaccuracy of reporting . it may also be due to the poor quality and/or amount of the training material . in general , undergraduate education and training on palliative care will be inadequate for the future practice of physicians unless it is supplemented with regular postgraduate continuous medical education . moreover , it was expected that the residents who are working in internal medicine , emergency , and surgery would have significantly better knowledge than their colleagues in other departments ( e.g. , dermatology , ophthalmology , etc . ) . this is based on the assumption that patients in the terminal state of illness and in need of palliative care are usually seen in one of these three specialties . however , our study revealed that the scores of the residents in these departments were not significantly better . resident physicians enrolled in postgraduate programs have less than adequate knowledge of basic palliative care . substantial efforts should be made to incorporate a module on palliative care in theoretical and practical training of medical students and resident physicians .
background : palliative care is a rapidly growing subspecialty that aims at improving the quality of life and relieving suffering associated with life threatening disease . despite its rapid growth and huge demand , the knowledge of health care professionals on palliative care remains inadequate.objective:this study aims to determine the knowledge of residents at king abdul - aziz university hospital ( kaauh ) on palliative care.materials and methods : through a cross - sectional design , all residents in the hospital were invited to complete a two - part self - administered questionnaire in june 2010 . 
 the first part of the questionnaire included variables describing the socio - demographic characteristics and educational background , and the second part developed by palliative care education initiative at dalhousie university in canada in 2000 had 25 items on the knowledge of palliative care.results:of the 80 residents 65 ( 81% ) responded , the overwhelming majority of whom were saudis ( 92.3% ) with an equal representation of males and females . the mean age of the participants was 29.1  2.4 years . 
 less than one - third ( 29.2% ) indicated that they had previous didactic education on palliative care . 
 the percentage of right answers on items reflecting knowledge on palliative care accounted for 29.9%  9.9% . 
 no statistically significant difference was found in the level of knowledge among the residents according to their demographics or graduation and training characteristics.conclusion:resident physicians enrolled in postgraduate programs have suboptimal knowledge of basic palliative care . 
 substantial efforts should be made to incorporate a palliative care module into the theoretical and practical training of medical students and resident physicians .