Development and validation of a measurement tool to assess perceptions of palliative care

Perception towards palliative care among patients with pulmonary hypertension in malaysia: a correlation with disease status

OBJECTIVES

This study aimed to describe the perception of Malaysian patients with pulmonary hypertension towards palliative care and their receptivity towards palliative care.

METHODS

This was a cross-sectional, single-centre study conducted via questionnaire. Patients aged 18 years old and above, who were diagnosed with non-curable pulmonary hypertension were recruited and given the assessment tool - perceptions of palliative care instrument electronically. The severity of pulmonary hypertension was measured using WHO class, N-terminal pro B-type natriuretic peptide and the 6-minute walking test distance.

RESULTS

A total of 84 patients [mean age: 35 ±11 years, female: 83.3%, median N-terminal pro B-type natriuretic peptide: 491 pg/ml (interquartile range: 155,1317.8), median 6-minute walking test distance: 420m (interquartile range: 368.5, 480m)] completed the questionnaires. Patients with a higher WHO functional class and negative feelings (r = 0.333, p = 0.004), and cognitive reaction to palliative care: hopeless (r = 0.340, p = 0.003), supported (r = 0.258, p = 0.028), disrupted (r = 0.262, p = 0.025), and perception of burden (r = 0.239, p = 0.041) are more receptive to palliative care. WHO class, N-terminal pro B-type natriuretic peptide, and 6-minute walking test distance were not associated with higher readiness for palliative care. In logistic regression analyses, patients with positive feelings (β = 2.240, p = < 0.05), and practical needs (β = 1.346, p = < 0.05), were more receptive to palliative care.

CONCLUSIONS

Disease severity did not directly influence patients' readiness for palliative care. Patients with a positive outlook were more receptive to palliative care.

Translation and psychometric validation of the Persian version of palliative care attitudes scale in cancer patients

INTRODUCTION

To improve cancer patients' quality of life, palliative care is necessary. The growth of palliative care, along with the assistance of the government and the collaboration of specialists, also relies on the knowledge and attitude of people. In Iran, there is no tool available to gauge patient attitudes about palliative treatment. The Persian version of the Palliative Care Attitude Scale (PCAS-9) was translated and psychometrically validated in this research among cancer patients.

METHODS

This methodological study was conducted in two stages: translation stage and psychometric validation stage. The method of translation was based on that proposed by Polit and Yang. Utilizing a qualitative approach, the scale's face and content validity were investigated. 162 cancer patients who required palliative care based on expert diagnosis participated in the confirmatory factor analysis to establish construct validity. Stability and internal consistency provided evidence of reliability. The data was examined using SPSS18 and AMOS.

RESULTS

The "Palliative Care Attitudes Scale" translated well across cultures. Validity on both the face and the content was acceptable. Confirmatory factor analysis (CFA) revealed a good fit for the original three-factor structure. The intra-class correlation coefficient (ICC) was equal to 0.89, while the internal consistency (Cronbach's alpha) reliability of the whole scale was equal to 0.77.

CONCLUSIONS

Persian version of the "Palliative Care Attitudes Scale" was acceptable and adequate in cancer patients. Using this tool makes it easier to assess how patients feel about receiving palliative care and how well training sessions are working to change patients' views.

Relationship Between Religion/Spirituality and the Aggressiveness of Cancer Care: A Scoping Review

CONTEXT

Religiosity/spirituality/religious-spiritual coping (RS) are resources used by cancer patients with cancer to help cope with the disease and may influence the preference and receipt of end-of-life (EOL) treatment.

OBJECTIVES

To examine the relationship between RS and the EOL care preferred or received by cancer patients.

METHODS

This review protocol is registered on (International Prospective Register of Systematic Review, CRD42021251833) and follows the recommendations of the preferred reporting items for systematic reviews and meta-analyses checklist. Embase, Proquest, PubMed, Scopus, and Web of Science databases were consulted. Google Scholar was consulted for additional publications and gray literature. Quantitative studies including adults with any cancer type/stage were eligible. The paper selection was performed by two independent reviewers; the methodological quality was measured using the Newcastle Ottawa scale.

RESULTS

Seventeen studies were included in the review. In general, RS is related to the preference or receipt of aggressive EOL care and with less advance care planning. Spiritual care by the medical team is related to higher referral to hospice and less aggressive care; in contrast, high spiritual support from religious communities is associated with less hospice and more aggressive care. Religious denominations influenced health care preferences, as Catholics were less likely to sign a do-not-resuscitate order and Buddhists or Taoists received more aggressive interventions at the EOL. Most studies (70%) were of high quality according to the Newcastle Ottawa scale.

CONCLUSION

RS is associated with more aggressive EOL treatments, as well as with lower rates of ACP in cancer patients. On the other hand, spiritual care provided by the medical team seems to be associated with less aggressive EOL care.

Factors Influencing the Willingness of Palliative Care Utilization among the Older Population with Active Cancers: A Case Study in Mandalay, Myanmar

Palliative care is an effective, multidisciplinary healthcare service to alleviate severe illness patients from physical, psychological, and spiritual pain. However, global palliative care has been underutilized, especially in developing countries. This cross-sectional survey aimed to examine the factors associated with older cancer patients’ willingness to utilize palliative care services in Myanmar. The final sample was composed of 141 older adults, 50-years of age and above who suffered from cancers at any stage. Simple random sampling was applied to choose the participants by purposively selecting three oncology clinics with daycare chemotherapy centers in Mandalay. We collected data using structured questionnaires composed of five sections. The sections include the participant’s socio-economic information, disease status, knowledge of palliative care, psychosocial and spiritual need, practical need, and willingness to utilize palliative care services. The study found that approximately 85% of older cancer patients are willing to receive palliative care services. The significant predictors of willingness to utilize palliative care services include place of living, better palliative care knowledge, more need for spiritual and psychosocial support, and practical support. This study can guide health policymakers in increasing the rate of palliative care utilization. The suggested policies include developing community-level palliative care services in Myanmar, especially in rural areas, promoting palliative care knowledge, applying appropriate religious and spiritual traditions at palliative treatment, and developing suitable medicines for the critically ill.

Associated factors of distress in patients with advanced cancer: A retrospective study

OBJECTIVE

The objective of this study was to assess the psychosocial distress and associated factors in advanced cancer patients consulting at the outpatient Palliative Care Unit at the National Cancer Institute in Mexico City.

DESIGN

A retrospective study was conducted using electronic records (June 2015 to December 2016).

SAMPLE

A total of 646 patients with advanced cancer during their first visit to the outpatient palliative care unit at the National Cancer Institute in Mexico were evaluated using the Distress Thermometer (DT) and ECOG performance status scores.

FINDINGS

Overall, 62% were women, with a median age of 57 years, and married (54.8%). The most frequent diagnosis was gastrointestinal cancer (28.6%), and 38.9% had a functional performance status of ECOG 2. The median DT score was 4.0 (IQR = 2-6), with 56% reporting DT scores ≥4. The three most frequent problems ≥4 were sadness (82.6%), feeling weak (81.2%), worry (79.6%), and <4 were feeling weak (57.7%), fatigue (55.6%), and financial security (52.1%). The variables associated with distress according to the multiple logistic regression analysis were problems with housing (OR = 2.661, 95% CI = 1.538-4.602), sadness (OR = 2.533, 95% CI = 1.615-3.973), transportation (OR = 1.732, 95% CI = 1.157-2.591), eating (OR = 1.626, 95% CI = 1.093-2.417), nervousness (OR = 1.547, 95% CI = 1.014-2.360), and sleep (OR = 1.469, 95% CI = 1.980-2.203).

CONCLUSION

The principal factors were related to distress levels, housing problems, transportation issues, and emotional problems such as sadness, nervousness, lower functionality, and younger age. Therefore, psychosocial support is of considerable relevance in palliative care. These findings will help clinicians understand the distress of patients with advanced cancer in palliative care in Latin American countries.

Development and Validation of the Palliative Care Attitudes Scale (PCAS-9): A Measure of Patient Attitudes Toward Palliative Care

CONTEXT

Palliative Care is underutilized, and research has neglected patient-level factors including attitudes that could contribute to avoidance or acceptance of Palliative Care referrals. This may be due in part to a lack of existing measures for this purpose.

OBJECTIVES

The objective of this study was to develop and validate a nine-item scale measuring patient attitudes toward Palliative Care, comprised of three subscales spanning emotional, cognitive, and behavioral factors.

METHODS

Data were collected online in three separate waves, targeting individuals with cancer (Sample 1: N = 633; Sample 2: N = 462) or noncancer serious illnesses (Sample 3: N = 225). Participants were recruited using ResearchMatch.org and postings on the web sites, social media pages, and listservs of international health organizations.

RESULTS

Internal consistency was acceptable for the total scale (α = 0.84) and subscales: emotional (α = 0.84), cognitive (αs = 0.70), and behavioral (α = 0.90). The PCAS-9 was significantly associated with a separate measure of Palliative Care attitudes (ps < 0.001) and a measure of Palliative Care knowledge (ps < 0.004), supporting its construct validity in samples of cancer and noncancer serious illnesses. The scale's psychometric properties, including internal consistency and factor structure, generalized across patient subgroups based on diagnosis, other health characteristics, and demographics.

CONCLUSION

Findings support the overall reliability, validity, and generalizability of the PCAS-9 in serious illness samples and have implications for increasing Palliative Care utilization via clinical care and future research efforts.

Barriers to Use of Palliative Care and Advance Care Planning Discussions for Patients With End-Stage Liver Disease

BACKGROUND & AIMS

Despite evidence for the benefits of palliative care (PC) referrals and early advance care planning (ACP) discussions for patients with chronic diseases, patients with end-stage liver disease (ESLD) often do not receive such care. We sought to examine physicians' perceptions of the barriers to PC and timely ACP discussions for patients with ESLD.

METHODS

We conducted a cross-sectional survey of hepatologists and gastroenterologists who provide care to adult patients with ESLD, recruited from the American Association for the Study of Liver Diseases 2018 membership registry. Using a questionnaire adapted from prior studies, we assessed physicians' perceptions of barriers to PC use and timely ACP discussions; 396 of 1236 eligible physicians (32%) completed the questionnaire.

RESULTS

The most commonly cited barriers to PC use were cultural factors that affect perception of PC (by 95% of respondents), unrealistic expectations from patients about their prognosis (by 93% of respondents), and competing demands for clinicians' time (by 91% of respondents). Most respondents (81%) thought that ACP discussions with patients who have ESLD typically occur too late in the course of illness. The most commonly cited barriers to timely ACP discussions were insufficient communication between clinicians and families about goals of care (by 84% of respondents) and insufficient cultural competency training about end-of-life care (81%).

CONCLUSION

There are substantial barriers to use of PC and timely discussions about ACP-most hepatologists and gastroenterologists believe that ACP occurs too late for patients with ESLD. Strategies are needed to overcome barriers and increase delivery of high-quality palliative and end-of-life care to patients with ESLD.

Physicians' Perspectives on Palliative Care for Patients With End-Stage Liver Disease: A National Survey Study

Specialty palliative care (PC) is underused for patients with end-stage liver disease (ESLD). We sought to examine attitudes of hepatologists and gastroenterologists about PC for patients with ESLD. We conducted a cross-sectional survey of these specialists who provide care to patients with ESLD. Participants were recruited from the American Association for the Study of Liver Diseases membership directory. Using a questionnaire adapted from prior studies, we examined physicians' attitudes about PC and whether these attitudes varied based on patients' candidacy for liver transplantation. We identified predictors of physicians' attitudes about PC using linear regression. Approximately one-third of eligible physicians (396/1236, 32%) completed the survey. Most (95%) believed that centers providing care to patients with ESLD should have PC services, and 86% trusted PC clinicians to care for their patients. Only a minority reported collaborating frequently with inpatient (32%) or outpatient (11%) PC services. Most believed that when patients hear the term PC, they feel scared (94%) and anxious (87%). Most (83%) believed that patients would think nothing more could be done for their underlying disease if a PC referral was suggested. Physicians who believed that ESLD is a terminal condition (B = 1.09; P = 0.006) reported more positive attitudes about PC. Conversely, physicians with negative perceptions of PC for transplant candidates (B = -0.22; standard error = 0.05; P < 0.001) reported more negative attitudes toward PC. In conclusion, although most hepatologists and gastroenterologists believe that patients with ESLD should have access to PC, they reported rarely collaborating with PC teams and had substantial concerns about patients' perceptions of PC. Interventions are needed to overcome misperceptions of PC and to promote collaboration with PC clinicians for patients with ESLD.

What do transplant physicians think about palliative care? A national survey study

BACKGROUND

Despite its established benefits, palliative care (PC) is rarely utilized for hematopoietic stem cell transplant (HSCT) patients. We sought to examine transplant physicians' perceptions of PC.

METHODS

We conducted a cross-sectional survey of transplant physicians recruited from the American-Society-for-Blood-and-Marrow-Transplantation. Using a 28-item questionnaire adapted from prior studies, we examined physicians' access to PC services, and perceptions of PC. We computed a composite score of physicians' attitudes about PC (mean = 16.9, SD = 3.37) and explored predictors of attitudes using a linear mixed model.

RESULTS

277/1005 (28%) of eligible physicians completed the questionnaire. The majority (76%) stated that they trust PC clinicians to care for their patients, but 40% felt that PC clinicians do not have enough understanding to counsel HSCT patients about their treatments. Most endorsed that when patients hear the term PC, they feel scared (82%) and anxious (76%). Nearly half (46%) reported that the service name 'palliative care' is a barrier to utilization. Female sex (β = 0.85, P = .024), having <10 years of clinical practice (β = 1.39, P = .004), and perceived quality of PC services (β = 0.60, P < .001) were all associated with a more positive attitude towards PC. Physicians with a higher sense of ownership over their patients' PC issues (β = -0.36, P < .001) were more likely to have a negative attitude towards PC.

CONCLUSIONS

The majority of transplant physicians trust PC, but have substantial concerns about PC clinicians' knowledge about HSCT and patients' perception of the term 'palliative care'. Interventions are needed to promote collaboration, improve perceptions, and enhance integration of PC for HSCT recipients.

Communication about palliative care: A phenomenological study exploring patient views and responses to its discussion

BACKGROUND

Communication about palliative care is a complex task frequently delayed until otherwise unavoidable. There is a need for discussion of palliative care to be viewed as a distinct communication task that is guided by empirical data. However, little is known of patient views and responses to these encounters.

AIM

To explore patient views surrounding communication about palliative care and their responses to its discussion.

DESIGN

Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework.

SETTING/PARTICIPANTS

Purposively sampled, English-speaking, adult patients with advanced cancer ( n = 30) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Australia.

RESULTS

Three major themes evolved. (1) Death as unspeakable: death was expressed using only implicit, ambiguous or technical terms and perceived to be outside the parameters of medical interactions. (2) Palliative care as a euphemism for death: the term 'palliative care' was perceived to be used by health professionals as a tool to talk about dying and understood by patients as a euphemism for death. (3) Palliative care as unspeakable: 'palliative care' was personified by patients to mean not just death, but my death, in turn, also becoming unspeakable.

CONCLUSION

This study provides important new patient insights and responses to the discussion of palliative care. Results demonstrate that the task of discussing palliative care remains complex, difficult and limited by our language. Greater consistency, sensitivity and sophistication are required when talking about palliative care to patients who may benefit from this care.

Initial perceptions of palliative care: An exploratory qualitative study of patients with advanced cancer and their family caregivers

BACKGROUND

Despite evidence for early integration of palliative care for people with advanced cancer and their families, patterns of late engagement continue. Prior research has focused on health professionals' attitudes to palliative care with few studies exploring the views of patients and their carers.

AIM

To explore initial perceptions of palliative care when this is first raised with patients with advanced cancer and their families in Australian settings.

DESIGN

Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework.

SETTING/PARTICIPANTS

Purposively sampled, English-speaking, adult patients with advanced cancer ( n = 30) and their nominated family caregivers ( n = 25) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Victoria, Australia.

RESULTS

Three major themes evolved which represent the common initial perceptions of palliative care held by patients with advanced cancer and their carers when this concept is first raised: (1) diminished care, (2) diminished possibility and (3) diminished choice. Palliative care was negatively associated with a system of diminished care which is seen as a 'lesser' treatment alternative, diminished possibilities for hope and achievement of ambitions previously centred upon cure and diminished choices for the circumstances of one's care given all other options have expired.

CONCLUSION

While there is an increasing move towards early integration of palliative care, this study suggests that patient and caregiver understandings have not equally progressed. A targeted public health campaign is warranted to disentangle understandings of palliative care as the 'institutional death' and to reframe community rhetoric surrounding palliative care from that of disempowered dying to messages of choice, accomplishment and possibility.

Perceptions of palliative care among patients with advanced cancer and their caregivers

BACKGROUND

Early palliative care is increasingly recommended but seldom practised. We sought to examine perceptions of palliative care among patients with advanced cancer and their caregivers.

METHODS

After conducting a cluster randomized controlled trial of early palliative care versus standard care for patients with advanced cancer, we approached patients and their caregivers to participate in semistructured interviews seeking to assess, qualitatively, their attitudes and perceptions about palliative care. We used the grounded theory method for data collection and analysis.

RESULTS

A total of 48 patients (26 intervention, 22 control) and 23 caregivers (14 intervention, 9 control) completed interviews. Participants' initial perceptions of palliative care in both trial arms were of death, hopelessness, dependency and end-of-life comfort care for inpatients. These perceptions provoked fear and avoidance, and often originated from interactions with health care professionals. During the trial, those in the intervention arm developed a broader concept of palliative care as "ongoing care" that improved their "quality of living" but still felt that the term itself carried a stigma. Participants in the intervention group emphasized the need for palliative care to be reframed and better explained by health care professionals. Participants in the control group generally considered it pointless to rename palliative care, but many in the intervention group stated emphatically that a different name was necessary in the early outpatient setting.

INTERPRETATION

There is a strong stigma attached to palliative care, which may persist even after positive experiences with an early palliative care intervention. Education of the public, patients and health care providers is paramount if early integration of palliative care is to be successful.

Application of the community oral health indicator by non-dental personnel and its contribution to oral healthcare

Objective

To validate the Community Oral Health Indicator-COHI by non-dental personnel.

Methods

Risk assessment is an essential component in the decision-making process. Therefore, the COHI, an instrument to evaluate population oral health situation in a simple manner, was created. Community Health Agents (CHA) were trained to use the COHI (variables as number of teeth, presence of cavities, residual dental roots, oral lesions, etc.), while dentists for the COHI and DMFT. 60 individuals were examined, by CHA and DS, with these indicators in order to validate the use of COHI by non-dental personnel.

Results

Dental and soft tissues problems were well spread among those individuals. People with and without soft tissue damage, as well as with and without use and/or need for prostheses were found in the sample, proving it to be a heterogeneous population for the evaluated factors and representing the real population. The results of examinations performed by dentists using the COHI and DMF-T/dmf-t presented strong agreement when comparing the two instruments. When COHI and DMFT were compared, the results showed a concordance of 0.86 for the number of present teeth, and 0.85 for the number of residual roots. Likewise, when analyzing the data comparing the use of the COHI by DS and CHA a high agreement level, specificity and sensitivity was found.

Conclusion

The COHI has shown to be useful for detecting problems in oral health. Therefore, COHI may be used, after training, by non-dental personnel, contributing to the planning and organization of the community dental assistance.