Myth Buster #3 Education changes practice

Everyone agrees that health professionals need more education regarding palliative care. But what can education alone accomplish in terms of changing behavior?  We have over 20 years of experience with cancer pain and palliative care education which has largely demonstrated that education alone does little to improve patient care.  If one looks at the major changes leading to clinician behavioral change, one finds elements of institutional systems change, rather than traditional education.  Systems change, a.k.a insitutional change, includes making pain a 5th vital sign, developing standards, policies and procedures for pain management, starting a palliative care consultation program, changing instutional formularies, etc.  Systems change helps to build a better system of care, which forces clinicians to adopt new ways of providing care in accordance with best practice standards.  In one stroke, a systems change approach (e.g. removing meperidine from a hospital formualary) can help overcome dysfunctional attitudes and poor knowledge.  I am not suggesting that education is useless--quite the contrary--education has a key role in reinforcing best practice standards.  But one should think about education as one part of a larger effort to improve care, an effort which needs to include a critical appraisal of how to change the system in a manner that promotes excellent care.