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Turkey is among the countries with only "capacity building activity"" in terms of palliative care development according to the mapping levels reported by the International Observatory on End of Life Care (http://www.eolc-observatory.net/global/pdf/world_map.pdf). Palliative care units are lacking even in major hospitals. Although some medical oncologists and pain specialists have been providing pain control and symptom relief to some extend, all these interventions remain a fragmented approach to care since there are no palliative care programs. Establishing palliative care services should be a priority in the development of comprehensive cancer care, particularly in a country where more than 60% of the cancer patients present with advanced stage disease. Like all the other university hospitals in the country, palliative care services have not been established so far in Dokuz Eylul University Hospital for several reasons although almost all the modern cancer treatment modalities have been provided to cancer patients. A group of health professionals have recently started a palliative care initiative in the hospital with an aim to raise awareness and to implement basic palliative care interventions to the current cancer care. This paper aims to tell the story of how this initiative get started and which step were taken so far.

A self-report questionnaire was answered by 114 nurses working at the internal medicine, oncology, and surgery clinics. The most commonly perceived barriers to pain management were system-related barriers. Lack of psychosocial support services and patient-to-nurse ratio received the highest ratings. Institutional and governmental attempts are needed to increase the number of nurses in the clinics and to establish support services. Nurse-related barriers were less perceived as an obstacle when compared with the other barriers. A small percentage of the nurses agreed that nurses' inadequate knowledge of pain management (10%) and nurses' indifference (8%) were barriers to pain management. Inadequate time for health teaching with patients was agreed on by 65% of the nurses. Most commonly rated physician-related barriers were inadequate assessment of pain and pain relief by doctors (63%) and physicians' indifference (47%). Patients' difficulty with completing pain scales (56%) and consumers not demanding results (53%) were the most commonly reported patient-related barriers. A significant percentage of the participating nurses indicated that they have no idea about patient-related barriers. Regular and continuous pain education programs may help to establish a supportive team spirit between doctors and nurses.