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Misconception between palliative care and euthanasia among Thai general practitioners: a cross-sectional study



Palliative care lower medical expenses and enhances quality of life, but misconception with euthanasia delays timely care and makes inappropriate patient management.


To examine the magnitude of misconceptions between palliative care and euthanasia among Thai general practitioners, explore the association with knowledge, attitudes, and practical experience, and assess the association between misconception and confidence in practicing and referring patients to palliative care centers.


All 144 general practitioners who were going to start residency training at Maharaj Nakorn Chiang Mai Hospital in 2021 participated in this observational cross-sectional study. A chi-square test was utilized to examine the relationship between misconception and knowledge, attitude, practical experience, confidence to practice, and confidence to refer patients. Multivariable logistic regression was carried out while controlling for age, sex, knowledge, attitude, and experience to examine the relationship between misconception and confidence to practice and refer patients for palliative care. Statistical significance was defined at p < 0.05.


About 41% of general physicians had misconceptions regarding palliative care and euthanasia. High knowledge was associated with a lower level of misconception (p = 0.01). The absence of misconceptions was weakly associated with a higher level of confidence in practicing palliative care, with an adjusted odds ratio of 1.51 (95% confidence interval 0.73 to 3.10, p = 0.07).


High misconception rates between palliative care and euthanasia among young Thai physicians might impact their confidence in delivering palliative care. Training initiatives for medical students and practitioners can mitigate misconceptions, fostering better palliative care utilization in Thailand.

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Palliative care (PC) provides specialized medical care and support to improve patients’ quality of life and reduce healthcare costs [1,2,3,4,5]. The primary goal of PC is to provide relief from symptoms such as pain, nausea, and shortness of breath and to address the physical, emotional, social, and spiritual needs of patients, which involves multiple actors and teamwork to deliver coordinated and integrative care [2, 6]. Previous study has shown that this service can save costs by reducing hospital readmissions, avoiding unnecessary treatments, and improving the efficient use of healthcare resources [7]. As a result, the demand for PC has increased during the last decade [8].

The ideal PC approach should be started at the early stage of the patient’s illness trajectory (e.g., after diagnosis of incurable conditions or after the disease begins to get worse), especially in patients with advanced cancer [9]. Early PC consultation provides more opportunities for patients and providers to prepare for symptom and emotional management when the last day comes [10, 11]. It was found that early PC consultation is associated with a lower length of hospital stay after consultation, fewer inpatient deaths, and higher hospice admission instead of long-term acute care [12].

However, the PC approach, particularly during end-of-life care, is often misunderstood as ‘euthanasia.‘ [13] People frequently inaccurately associated PC with patients losing hope, perceived as a period of waiting for death when all treatment options have been exhausted [14]. The prevalence of misconceptions about these terms in healthcare professionals ranged between 2–56%, depending on the topics [15], reflecting a significant need for education and awareness regarding PC’s true nature and benefits.

Misconception is defined as ideas that are inconsistent with scientific knowledge and result in misunderstanding and misinterpretation [16]. In this study, we examined ideas that are inconsistent with scientific knowledge about PC and euthanasia and the subsequent potential decrease in confidence in practising and referring patients for PC. Euthanasia is the act of intentionally ending a person’s life to relieve their suffering [17]. It is typically administered by a healthcare professional or another person at the patient’s request. Euthanasia can be either voluntary (with the explicit consent of the patient) or involuntary (without the patient’s consent, which is illegal in many places) [18], and either active (taking a direct action to end a patient’s life, such as administering a lethal injection) and passive (withholding or withdrawing life-sustaining treatments with the expectation that it will lead to the patient’s death) [19].

Physicians may occasionally misunderstand the difference between PC and euthanasia because of a lack of education and training, complex ethical and legal frameworks, and cultural and personal beliefs [20,21,22,23]. Medical professionals may not receive adequate education and training in end-of-life care, including PC principles, which results in a limited understanding of the distinctions between these terms. The ethical and legal landscape surrounding end-of-life care can be complex and vary widely by region, making it challenging for physicians to navigate these complexities. Finally, cultural, religious, or personal beliefs can influence a physician’s perspective on end-of-life care, which leads to differing interpretations of what constitutes appropriate care in a given situation.

In Thailand, PC needs have been rising due to the aging society [24,25,26]. The government is running political actions to promote PC in primary care settings, including caring for patients at home, hospitals, and hospices [25]. The number of medical schools opening PC-related curricula (e.g., PC fellowship and residency) or integrating PC knowledge into medical student programs is increasing to provide appropriate PC in Thailand. Around 2,000 medical students graduate as GP yearly. Most new graduates will spend up to three years as a GP in general hospitals before returning for further specialisation. In these first three years, they will need to care for common conditions in community hospitals, both in-patient and out. These tasks will include caring for terminally ill patients at the hospital, the patient’s home, or nursing home [27].

While PC is widely accepted, euthanasia is not legally sanctioned. Assisting or participating in euthanasia can lead to criminal charges in the country. Thus, investigating the magnitude of misconception between PC and euthanasia is important in terms of evaluating the provider’s understanding and the appropriateness of the training programs.

Misconceptions are associated with several factors. It is influenced by providers’ knowledge, attitude, and practical experience (KAP) [28,29,30,31]. A lack of knowledge, negative attitude, and insufficient professionalism in healthcare providers during the management of end-of-life in terminally ill patients can contribute to both medical and ethical problems. Misconception may also affect doctors’ performance, leading to low confidence in delivering PC and referring patients to PC centers [32]. This consequence could contribute to the delay of treatment and inappropriate management of PC patients.

Therefore, the primary objective of this study is to explore the magnitude and details of the misconception between PC and Euthanasia among Thai general practitioners. The secondary objectives are (1) to investigate the association between knowledge, attitude, practical experience, and misconception and (2) to investigate the association between misconception and confidence to practice PC and refer patients to PC centers. The conceptual framework of this study is shown in Fig. 1.

Fig. 1
figure 1

Conceptual framework of the study


Study design, setting, and participants

A cross-sectional study was conducted among all 144 general practitioners about to start residency training at Maharaj Nakorn Chiang Mai Hospital in 2021. Maharaj Nakorn Chiang Mai Hospital is a university hospital in Chiang Mai province (the center of northern Thailand) providing care and treatment in many specialties. Researchers recruited all these general practitioners on the first day of orientation before they started their residency training.

Sample size

According to the previous literature, the estimated percentage of healthcare professionals who misunderstand PC and euthanasia is 17.1% [15]. Using sample size calculation for one proportion [33], with an estimated error of 0.1, at least 55 participants are required for the survey.


A self-administered, structured questionnaire was developed for this study by applying different sources of evidence (Supplementary File 1). The questionnaire consisted of the following sections:

Participants’ background

This section covered age, sex, years of working experience after graduation, PC topics studied during Medical School, and additional training on PC after graduation.

Misconception between PC and euthanasia

This section included a total of 8 statements about palliative care or euthanasia. For each statement, participants had to identify whether the statement was true or false. Five statements were about PC principles characterized by The European Association of Palliative Care (EAPC) regarding palliative sedation, living will, opioids used to relieve intolerable symptoms, and withholding/withdrawing life-sustaining treatment [34,35,36,37]. Three statements were about euthanasia, regarding intentionally ending a person’s life under the administration of a physician by using medication [35, 38, 39]. The questionnaire was piloted in several GPs and checked for its content-related validity by 2 PC experts before being used in this study. Responses from participants were scored, with correct responses receiving one point and wrong ones obtaining zero points. Scores ranged from 0 to 8, with a score of 8 indicating no misconceptions (between palliative care and euthanasia) and less than eight suggesting misconceptions.

Knowledge about PC

This section included a total of 16 multiple choice questions (one best answer) regarding the delivery of bad news, various cancer treatment modalities, appropriate reasons for referring patients to hospice, cancer pain management, different types of opioids, non-pain management, management in final days, emergency symptoms management and psychological care. The questions were adopted from a prior Thai study by Budkaew and Chumworathayi [40]. Additional contents on living will and advanced care planning were also added. Scores ranged from 0 to 16, with the threshold between low and high levels of knowledge defined by the interquartile range (IQR).

Attitude towards PC

This section included 22 questions regarding attitudes toward PC, such as the importance of PC and PC planning. These attitude questions were adopted from the study by Budkaew and Chumworathayi [40]. A 5-point Likert scale ranged from ‘strongly disagree’ [1] to ‘strongly agree’ [5]. Total attitude scores ranged from 22 to 110, and the IQR determined the threshold between low and high levels of (positive) attitude towards PC.

Practical experience with PC

The set of questions about practical experience was developed to ascertain participants’ experience in caring for PC patients throughout their careers by asking about the number of PC cases they have encountered. The responses were categorized into three categories: 0, 1–9, and 10 cases and over.

Level of confidence to practice PC and to refer patients to PC center

Lastly, confidence in performing PC was assessed across two aspects: caring for patients with palliative conditions and referring patients to PC centers. Each aspect of confidence was rated from 0 to 10, with higher scores indicating greater confidence. The median score was determined, with scores more than the median representing a high confidence level and scores less than the median representing a low level of attitude.

Data analysis

The data analysis was conducted using SPSS version 25. For socio-demographic characteristics, misconceptions, KAP scores, confidence to practice, and confidence to refer patients were analyzed using frequency and percentage for categorical data and mean with its standard deviation for continuous data. The chi-square test was used to test the association between knowledge, attitude, practical experience, confidence to practice, confidence to refer patients, and misconception. Multivariable logistic regression was performed to investigate the association between misconception and confidence to practice and refer patients for PC, adjusting for age, sex, knowledge, attitude, and experience. Statistically significant associations were set as those with a p-value less than 0.05.


Participants’ background

One hundred and forty-four general practitioners participated in this study. The mean age was 26.4 years, which ranged between 23 and 38 years. The proportions between men and women were similar. On average, participants had worked for 1.77 years, with 48.6% working for one year or less. Most of these participants (N = 137/144) studied at least one topic about PC when they were medical students. During medical school, the majority were taught about pain management (84.7%), advance care planning (74.5%), living will (65.7%), end-of-life care (59.1%), and PC systems (54.0%). However, less than half were taught about family and caregiver support (43.8%) and other symptom management (43.8%). After graduation, only 27.1% had undergone any additional palliative care training (See Table 1).

Table 1 Participants’ background

Misconceptions between palliative care and euthanasia

41% of participants had at least one misconception between PC and Euthanasia. The questions that were frequently answered incorrectly pertained to the misunderstanding that following patients’ living will by withdrawing endotracheal intubation is euthanasia (16.7%) and using sedative drugs or muscle relaxants to hasten the end of a patient’s life is PC (16.0%). Additionally, there were misconceptions surrounding allowing patients to die at home as wished is euthanasia (12.5%), and employing sedative drugs for symptom control is euthanasia (12.5%). However, most physicians answered questions correctly regarding morphine use to hasten death as euthanasia and relieving respiratory distress is PC (See Table 2).

Table 2 Detail of misconception between PC and euthanasia

Relationships between KAP and misconceptions

Both higher knowledge and attitude were linked to the absence of misconceptions, yet statistical significance was solely observed in the association between knowledge and misconception. Having high knowledge of PC was associated with lower proportions of misconceptions (p = 0.01). 70% of the total participants had experience in palliative care work. But only 13.9% had cared for more than 10 cases. The proportion with misconception varied by prior practical experience, but the observed differences were not statistically significant (p-value = 0.674) (See Table 3).

Table 3 Association between knowledge, attitude, practical experience, confidence, and misconception

Relationships between misconceptions and level of confidence to practice and refer patients to PC center

The absence of misconception was related to a higher level of confidence in both practicing and referring; however, only weak evidence of an association between misconception and confidence to practice was shown (confidence to practice: adjusted OR 1.15, 95% CI 0.73–3.10, p-value = 0.068; confidence to refer: adjusted OR 1.51, 95% CI 0.75–3.03, p-value = 0.773) (See Table 4).

Table 4 Association between misconception and confidence to practice PC and refer patient for PC


This study found that the prevalence of misconception among general practices is common. Many physicians misunderstood that withdrawing life-sustaining procedures as indicated in the patient’s living will and discharging palliative patients to die at home are part of euthanasia. At the same time, some are confused that using sedative drugs and muscle relaxants to fasten patients’ death is palliative care, but using them to relieve suffering is euthanasia. High knowledge, a high positive attitude, and high practical experience were associated with a lower risk of misconception. However, a significant difference was only observed in the association of misconception with knowledge. The absence of misconceptions was weakly associated with higher confidence to practice PC.

To our knowledge, this is the first study investigating among physicians the magnitude of misconception between PC and Euthanasia in Thailand. Most participants were taught about pain management and advanced care planning in undergraduate courses, but other topics were less likely to be taught. Therefore, physicians answered questions about morphine use and family meeting more correctly than the others. These findings corresponded with a study among Canadian physicians, which found that symptom management and communication skills are the competency areas readily taught, and what we need now is a program tailored to practice contexts [41]. Our findings suggest that further development of undergraduate PC courses should focus more on other topics, such as the contents of discontinuing unnecessary medical procedures and utilizing sedative drugs and muscle relaxants in terminally ill patients.

This study investigated the relationship between misconception and its contributing factors: knowledge, attitude, and practice/experience. Previous studies showed that knowledge, attitude, and misconception interact with each other, as good knowledge and a positive attitude promote a better understanding of the concept [1] and a low level of misconception was associated with a more positive attitude [42]. Therefore, building a good understanding of PC among GPs requires knowledge improvement and positive attitude development. Our study showed a similar trend as physicians with high knowledge and positive attitudes had a lower percentage of misconception. However, even with a large proportion of those with good knowledge and attitude, the percentage of misconception is still high. This might be due to another contributing factor, such as practical experience [28,29,30,31].

More than half of the surveyed physicians in this study performed PC. However, most of them managed fewer than 10 cases throughout their careers. This trend can be attributable to their relatively new status as medical practitioners, as the participants’ average age was 26.4 years, and Thai medical students typically complete their education by the age of 24–25 years. Moreover, as there is no formal training in PC for undergraduate students in Thailand, it is less likely for medical students to have experience in PC management, only being lectured in the classroom. A lack of adequate practical experience may affect students’ understanding of the concept of PC in depth. Previous study revealed that enhanced practical experiences strengthen understanding, theoretical knowledge, and concepts, attributed to clinical exposure [43,44,45]. Therefore, the evidence in our study suggested that further PC training for both undergraduate and postgraduate medical students should provide more hours for them to manage terminally ill patients, as training is crucial to enhance one’s knowledge, attitude, and practical experience when performing medical tasks [46,47,48].

Finally, our study supports that misconception was weakly associated with lower confidence to deliver care. They may experience ethical and moral dilemmas when they believe they are being asked to participate in or provide euthanasia, even when they are actually providing palliative care [49, 50]. They may fear legal repercussions for providing palliative care that is incorrectly perceived as euthanasia [51]. These dilemmas and fears can create internal conflicts and reduce their confidence in their ability to provide appropriate care [52]. Our study showed those who misunderstood were more likely to have low confidence. Previous study also demonstrated similar finding on the relationship between misconception and the level of confidence to deliver care [53, 54]. However, many factors are involved in this association [55], and further studies exploring the causal relationship between these variables are suggested.

Therefore, based on the KAP framework and findings in this study, we suggest improving GPs’ knowledge and practical experience. Undergraduate curricula should include topics related to (1) discontinuation of unnecessary medical procedures and (2) management of sedatives, analgesics, and muscle relaxants in PC patients. Case-based learning and short didactic lectures have demonstrated the potential to expand and distribute knowledge and skills in the field of PC [56]. They have significantly increased physicians’ confidence in practising PC in the Thai context [57].


First, the sample size was small, which resulted in low power; thus, some findings were only marginally significant. We recruited general practitioners from only one site. Further study should be conducted to improve generalizability. Lastly, there will be limitations regarding causal relationships between variables due to the cross-sectional design. However, there are also some strengths to our study. It is one of the first studies that examines the extent of misconception between PC and euthanasia among physicians in Thailand, and results could be useful in other settings where formal training in palliative care is in its early stages. Additionally, the tool for evaluating misconceptions between PC and euthanasia was developed from international definitions and standards. The findings of this study should have implications for educational interventions, policy formulation, and professional training programs aiming at improving physicians’ understanding of PC and associated ethical issues.


This study highlights the high prevalence of misconception between palliative care and euthanasia among young Thai physicians, which might affect their confidence in delivering palliative care in practice. Providing medical students and general practitioners with training and additional opportunities to handle palliative care patients may be useful in reducing misconceptions between palliative care and euthanasia and promoting the utilization of palliative care in Thailand.

Data availability

The data supporting the findings in this manuscript are available upon reasonable request to the corresponding author due to ethical agreement on data privacy.



Palliative Care


  1. Flieger SP, Chui K, Koch-Weser S. Lack of awareness and common misconceptions about palliative care among adults: insights from a national survey. J Gen Intern Med. 2020;35:2059–64.

    Article  PubMed  PubMed Central  Google Scholar 

  2. World Health Organization. Palliative Care Geneva: World Health Organization. 2020.

  3. Aldridge MD, Hasselaar J, Garralda E, van der Eerden M, Stevenson D, McKendrick K, et al. Education, implementation, and policy barriers to greater integration of palliative care: a literature review. Palliat Med. 2016;30(3):224–39.

    Article  PubMed  Google Scholar 

  4. May P, Normand C, Cassel JB, Del Fabbro E, Fine RL, Menz R, et al. Economics of palliative care for hospitalized adults with serious illness: a meta-analysis. JAMA Intern Med. 2018;178(6):820–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. World Health Organization. Global Atlas of Palliative Care: World Health Organization. 2nd ed. 2020.

  6. Meier DE, Back AL, Berman A, Block SD, Corrigan JM, Morrison RS. A national strategy for palliative care. Health Aff. 2017;36(7):1265–73.

    Article  Google Scholar 

  7. Reid EA, Kovalerchik O, Jubanyik K, Brown S, Hersey D, Grant L. Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review. BMJ Support Palliat Care. 2019;9:120–9.

    Article  PubMed  Google Scholar 

  8. Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. Lancet Glob Health. 2019;7:e883–92.

    Article  PubMed  PubMed Central  Google Scholar 

  9. National Cancer Institute. Study confirms benefits of early palliative care for advanced cancer Maryland: National Cancer Institute. 2016.

  10. Seow H, Sutradhar R, Burge F, McGrail K, Guthrie DM, Lawson B, et al. End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study. BMJ Open. 2021;11:e041432.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Howie L, Peppercorn J. Early palliative care in cancer treatment: rationale, evidence and clinical implications. Ther Adv Med Oncol. 2013;5(6):318–23.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Reyes-Ortiz CA, Williams C, Westphal C. Comparison of early versus late palliative care consultation in end-of-life care for the hospitalized frail elderly patients. Am J Hosp Palliat Med. 2015;32:516–20.

    Article  Google Scholar 

  13. Inbadas H, Carrasco JM, Clark D. Representations of palliative care, euthanasia and assisted dying within advocacy declarations. Mortality (Abingdon, England). 2019;25(2):138–50.

  14. Pennell M. Time to debunk some palliative care myths. Int J Palliat Nurs. 2004;10(12):577.

    Article  PubMed  Google Scholar 

  15. Dixe MDA, Santo IDO, Lopes S, Catarino H, Duarte S, Querido A, Laranjeira C. Knowledge and myths about palliative care among the general public and health care professionals in Portugal. Int J Environ Res Public Health. 2020;17(13).

  16. Olde Bekkink M, Donders ARTR, Kooloos JG, de Waal RMW, Ruiter DJ. Uncovering students’ misconceptions by assessment of their written questions. BMC Med Educ. 2016;16(1):221.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Annadurai K, Danasekaran R, Mani G. Euthanasia: right to die with dignity. J Family Med Prim Care. 2014;3:477–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Vizcarrondo FE. Editorial euthanasia and assisted suicide: the physician’s role. Linacre Q. 2013;80:99–102.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Brassington I. What passive euthanasia is. BMC Med Ethics. 2020;21:41.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Morita T, Tsuneto S, Shima Y. Proposed definitions for terminal sedation. Lancet (London England). 2001;358(9278):335–6.

    Article  CAS  PubMed  Google Scholar 

  21. Morita T, Hirai K, Akechi T, Uchitomi Y. Similarity and difference among standard medical care, palliative sedation therapy, and euthanasia: a multidimensional scaling analysis on physicians’ and the general population’s opinions. J Pain Symptom Manage. 2003;25:357–62.

    Article  PubMed  Google Scholar 

  22. Hermsen MA, ten Have HA. Moral problems in palliative care journals. Palliat Med. 2001;15(5):425–31.

    Article  CAS  PubMed  Google Scholar 

  23. Hermsen MA, ten Have HA. Euthanasia in palliative care journals. J Pain Symptom Manage. 2002;23(6):517–25.

    Article  PubMed  Google Scholar 

  24. Nilmanat K. Palliative care in Thailand: development and challenges. Can Oncol Nurs J. 2016;26(3):262–4.

    PubMed  PubMed Central  Google Scholar 

  25. Kunakornvong W, Ngaosri K. Public awareness and attitude toward palliative care in Thailand. Siriraj Med J. 2020;72:424–30.

    Article  Google Scholar 

  26. World Health Organization. Thailand’s leadership and innovations towards healthy ageing: World Health Organization. 2023.

  27. PBS T. - [news]. 2023 [updated 6 June 2023.

  28. Awny MM, Al-Touny SA, Gaafar SEM. Physicians’ knowledge, attitude and practice toward ethical and medical issues of palliative care in Suez Canal University Hospital. Indian J Palliat Care. 2022;28(4):391–7.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Getie A, Wondmieneh A, Mengesha A, Fitwi A, Gedefaw G, Demis A. Assessment of knowledge and attitude towards palliative care and associated factors among nurses working in North Wollo Hospitals. Ethiop J Health Sci. 2021;31(2):393–400.

    PubMed  PubMed Central  Google Scholar 

  30. Hamdan N, Yaacob LH, Idris NS, Abdul Majid MS. Primary care physicians’ knowledge and attitudes regarding palliative care in Northeast Malaysia. Healthc Healthc. 2023;11:1–8.

    Google Scholar 

  31. Anteneh S, Kassa H, Demeke T, Guadu T. Assessment of nurses’ knowledge, attitude, practice and associated factors towards palliative care. Adv Biol Res. 2016;10(2):110–23.

    Google Scholar 

  32. Montagnini M, Smith HM, Price DM, Ghosh B, Strodtman L. Self-perceived end-of-life care competencies of healthcare providers at a large academic medical center. Am J Hosp Palliat Care. 2018;35:1409–16.

    Article  PubMed  Google Scholar 

  33. Wayne WD, Biostatistics. A foundation of analysis in the health sciences 6ed. John Wiley & Sons, Inc.; 1995. p. 180.

  34. Cherny NI, Radbruch L, Board of the European Association for Palliative Care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009;23:581–93.

    Article  PubMed  Google Scholar 

  35. Materstvedt LJ, Clark D, Ellershaw J, Førde R, Gravgaard AM, Müller-Busch HC, et al. Euthanasia and physician-assisted suicide: a view from an EAPC ethics task force. Palliat Med. 2003;17:97–179.

    Article  PubMed  Google Scholar 

  36. Radbruch L, Leget C, Bahr P, Müller-Busch C, Ellershaw J, de Conno F, et al. Euthanasia and physician-assisted suicide: a white paper from the European association for palliative care. Palliat Med. 2016;30:104–16.

    Article  PubMed  Google Scholar 

  37. Twycross R. Reflections on palliative sedation. Palliat Care. 2019;12:1–16.

    Google Scholar 

  38. Albaladejo A. Fear of assisted dying: could it lead to euthanasia on demand or worsen access to palliative care? BMJ (Clinical Res ed). 2019;364:1852.

    Google Scholar 

  39. Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA. 2016;316:79–90.

    Article  CAS  PubMed  Google Scholar 

  40. Budkaew J, Chumworathayi B. Knowledge and attitudes toward palliative terminal cancer care among Thai generalists. Asian Pac J Cancer Prev. 2013;14:6173–80.

    Article  PubMed  Google Scholar 

  41. Downar J. Resources for educating, training, and mentoring all physicians providing palliative care. J Palliat Med. 2018;21:S57–62.

    Article  PubMed  Google Scholar 

  42. Feleke A, Adane M, Embrandiri A, Berihun G, Walle Z, Keleb A, Kloos H. Knowledge, attitudes, and misconceptions about COVID-19 prevention practices among high and preparatory school students in Dessie City, Ethiopia. J Multidiscip Healthc. 2022;15:1035–55.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Leask R, Cronje T, Holm DE, Van Ryneveld L. The impact of practical experience on theoretical knowledge at different cognitive levels. J S Afr Vet Assoc. 2020;91:e1–7.

    Article  PubMed  Google Scholar 

  44. Walley S, Albadri S. Undergraduates’ perceptions of the value of practical inhalation sedation experience in a UK dental school. Eur Arch Paediatr Dent. 2015;16(5):371–6.

    Article  CAS  PubMed  Google Scholar 

  45. Hashemiparast M, Negarandeh R, Theofanidis D. Exploring the barriers of utilizing theoretical knowledge in clinical settings: a qualitative study. Int J Nurs Sci. 2019;6(4):399–405.

    PubMed  PubMed Central  Google Scholar 

  46. Salem KA, Balahmar MK, Milaat W, Gabal MS. The effects of a training program on knowledge, attitude and practice of the staff of primary health care centers towards growth monitoring: an intervention study. J Egypt Public Health Assoc. 1999;74(5–6):627–49.

    CAS  PubMed  Google Scholar 

  47. Mekrungrongwong S, Kitreerawutiwong N, Keeratisiroj O, Jariya W. Self-perceived knowledge, attitudes, and training needs regarding medical cannabis among health care providers and health volunteers in district health systems, Phitsanulok Province. BMC Prim Care. 2022;23:266.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Methakanjanasak N, Surit P, Ruaisungnoen W, Saensom D, Somjaivong B, Silarat M, et al. Effects of the workshop training on knowledge, attitudes, and skills of basic first-aid among working-age people. J Nurs Sci Health. 2021;44(3):58–70.

    Google Scholar 

  49. Kinzbrunner BM. Ethical dilemmas in hospice and palliative care. Support Care Cancer. 1995;3(1):28–36.

    Article  CAS  PubMed  Google Scholar 

  50. Akdeniz M, Yardımcı B, Kavukcu E. Ethical considerations at the end-of-life care. SAGE Open Med. 2021;9:1–9.

    Article  Google Scholar 

  51. Willmott L, White B, Piper D, Yates P, Mitchell G, Currow D. Providing Palliative Care at the end of life: should Health professionals Fear Regulation? J Law Med. 2018;26:214–45.

    PubMed  Google Scholar 

  52. Vesel T, Beveridge C. From fear to confidence: changing providers’ attitudes about pediatric palliative and hospice care. J Pain Symptom Manage. 2018;56:205–12.

    Article  PubMed  Google Scholar 

  53. Hecimovich M, Volet S. Development of professional confidence in health education: research evidence of the impact of guided practice into the profession. Health Educ. 2011;111(3):177–97.

    Article  Google Scholar 

  54. Kim MK, Arsenault C, Atuyambe LM, Macwan’gi M, Kruk ME. Determinants of healthcare providers’ confidence in their clinical skills to deliver quality obstetric and newborn care in Uganda and Zambia. BMC Health Serv Res. 2020;20:539.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Ogawa T, Nakatani H. Factors associated with professional confidence in Japanese public health nurses: a cross-sectional survey. Public Health Nurs. 2020;37:272–80.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Usher R, Payne C, Real S, Carey L, Project ECHO. Enhancing palliative care for primary care occupational therapists and physiotherapists in Ireland. Health Soc Care Community. 2022;30(3):1143–53.

    Article  PubMed  Google Scholar 

  57. Buawangpong N, Chutarattanakul L, Dejkriengkraikul N, Chumintrachark A, Ratanasiri T, Pinyopornpanish K, et al. Perceptions of learners and specialists toward ECHO palliative care project in Thailand. J Prim Care Community Health. 2024;15:21501319241237058.

    Article  PubMed  PubMed Central  Google Scholar 

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Sincere acknowledgment is expressed by the authors to all study participants.


The study was partially supported by Chiang Mai University (LC, CA and NW).

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Authors and Affiliations



The authors confirm contribution to the paper as follows: conceptualization: LC, ND, MO, CA, NW, data collection: LC, VJ, ND, ST, data analysis: LC, ND, VJ, MO, NW, data validation: NW, CA, MO, ST, draft manuscript: LC, ND, VJ, MO, revise manuscript: MO, NW, CA. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Nutchar Wiwatkunupakarn.

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Ethics approval and consent to participate

This study was approved by the Faculty of Medicine, Chiang Mai University ethics committee (Research ID: 098/2563). Informed consent was obtained from all subjects in this study.

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Not applicable.

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The authors declare no competing interests.

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Chutarattanakul, L., Jarusukthavorn, V., Dejkriengkraikul, N. et al. Misconception between palliative care and euthanasia among Thai general practitioners: a cross-sectional study. BMC Palliat Care 23, 96 (2024).

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