7days, we considered the assessment of cancer pain by primary and palliative care physicians to have been performed at the same time. In addition, primary physicians documented the reason for referral to a PCT, and the intensity and locations of pain were documented by primary physician. The form for palliative care

physicians comprised three Inhibitors,research,lifescience,medical parts; patients’ checklists documented by palliative care physicians, characteristics of pain rated by patients, and assessment and therapy plan documented by palliative care physicians. The characteristics of pain, such as a diagram of locations of pain, and intensity of pain as measured in the patient’s marks on the NRS, were based on the Brief Pain Inventory (BPI) [17]. For patients who could not verbalize, palliative Inhibitors,research,lifescience,medical care physicians assessed the patients’ pain using the APS instead of the NRS [16] as rated by patients. The palliative care physicians considered the characteristics of pain in their assessments and therapy plans. The data recorded included the reason for consultation, the demographics of the patients, and the history of illness. To directly compare the assessments of primary and palliative care

physicians, we defined accurate pain assessment as the identification of existing pain by both primary and palliative care physicians using the standard format at the time of the initial PCT consultation. Under-diagnosis Inhibitors,research,lifescience,medical of pain was defined as the identification of pain by only palliative care physicians. Exposure: interval between admission and the initial PCT consultation Various definitions of “palliative care consultation” or “referral”

have been proposed [17,18]. The present study defined referral to the PCT as receipt Inhibitors,research,lifescience,medical by the PCT of documents requesting advice or assistance in directing patient management that were signed by the click here physician who was primarily responsible for the care of the patient. We defined an interval of 20days between hospital admission and initial PCT consultation as the cut-off point Inhibitors,research,lifescience,medical between early and late referral. Because time between early and late referral was significantly different and had a non-normal distributions, we performed a dichotomous rather than continuous analysis. Covariates Covariates that can affect pain assessment by a physician include patient demographics, such as age (continuous), gender, primary cancer site, Karnofsy Performance Status Tryptophan synthase (KPS), therapy status, purpose of admission, current opioid use at the initial PCT consultation, duration of hospitalization, coexistence of delirium, as well as physician characteristics, such as years of experience (<6, 6–10, >10years), and clinical department. Current opioid use at the initial PCT consultation has been shown to affect the prescription of opioids by a primary physician and to reflect a physician’s knowledge of palliative care [12].