Table 2 Factor structure of the new factor solution

Main component

 1 Preparation to provide palliative care

  1. Care for patients at the end of life.

  2. Breaking bad news to a patient about his or her illness.

  3. Managing patients’ emotional suffering at the end of life.

  4. Discussing end-of-life care decisions, such as a DNR^b order, with a patient.

  5. Managing ethical issues that arise in caring for patients near the end of life.

  6. Helping family members during bereavement.

  7. Discussing spiritual issues.

  8. Discussing patient/ family psychosocial needs and concerns.

  9. Addressing cultural differences related to end-of-life care.

  10. Addressing age-related developmental differences in end-of-life care.

  11. Responding to a patient’s question “Will I suffer much or have pain?”.

  12. Your ability to determine patients’ needs.

  13. Physicians have an obligation to tell patients when death is imminent.

 2 Attitudes towards palliative care

  1. There is little that can be done to ease the suffering of grief.^c

  2. The physician/nurse has a responsibility to provide bereavement care to the patient’s family after death.

  3. It is not possible to tell patients the truth about a terminal prognosis and maintain hope.^c

  4. Psychological suffering can be as severe as physical suffering.

  5. At their request, patients with terminal illnesses should be given whatever medications are necessary to relieve pain, even if the medications hasten death.

  6. Talking about death tends to make patients with terminal illnesses more discouraged.^c

  7. Depression is not treatable in patients with terminal illnesses.^c

  8. The physician’s/nurse’s responsibility is to the patient; other professionals should deal with the needs of the family.^c

  9. Physicians/nurses have a responsibility to help patients prepare for death.

  10. An interdisciplinary team approach to terminal illness treats patients’ medical needs better than conventional care.

 3 Self-estimation of competence in communication with dying patients and their relatives

  1. Depression is normal in patients with terminal illness.

  2. Family members tend to interfere in the care of patients with terminal illnesses.^c

  3. Discussing possible symptoms of an incurable illness with patients.

  4. Discussing possible symptoms of an incurable illness with the family.

  5. Discussing death with patients.

  6. Discussing the nearby death of patients with the family.

  7. Discussing with the family after patients’ death.

  8. Responding to a patient’s question “How long do I still have to live?”.

 4 Self-estimation of knowledge and skills in palliative care

  1. Managing pain in terminal illness.

  2. Managing dyspnea or respiratory distress in terminal illness.

  3. Your knowledge concerning the aetiology of palliative patients’ frequent symptoms.

  4. Your ability to manage palliative patients’ frequent symptoms.

  5. Your knowledge concerning the therapeutic and adverse effects of analgetics.