Palliative Care Education in the Developing Countries

Perceptions, knowledge and attitudes towards the concept and approach of palliative care amongst caregivers: a cross-sectional survey in Karachi, Pakistan

Background

Limited comprehension of the concept of palliative care and misconceptions about it are barriers to meaningful utilisation of palliative care programs. As caregivers play an integral role for patients with terminal illness, it is necessary to assess their perceptions and attitudes towards the palliative care approach.

Method

A cross-sectional survey was conducted. Data was collected from the Aga Khan Hospital in-patient and out-patient departments and home-based palliative care services. All adult caregivers who met the inclusion criteria and consented, completed a questionnaire till the sample size was reached. Univariate and multivariate multivariable analysis was done and results were reported as crude prevalence’s, crude and adjusted prevalence ratios with 95% confidence intervals using Cox-proportional hazard algorithm. Mean difference of knowledge and attitude scores by caregiver variables were assessed using one-way ANOVA. SPSS version 18 was used and a p-value of less than 5% was treated as significant.

Results

Out of 250 caregivers more than 60% were 40 years or less, majority were males and at least graduates. Approximately 70% of the respondents agreed with the statement that the person suffering from cancer should be informed about the diagnosis and disease progression. About 45% (95% C.I.: 39.03, 51.37%) of the study respondents had enhanced understanding about palliative care. Individuals under 40 years old, those with an education level of at least grade 10, children or relatives were found to have significantly more enhanced knowledge about palliative care. The majority believed that the patient should be informed about the diagnosis and should be facilitated to carry out routine activities and fulfill their wishes.

Conclusion

Nearly half of the caregivers had enhanced understanding of the palliative care approach. They showed consistent understanding of two foundational aspects indicating correct knowledge across age groups, gender, education level, and relationship with the patient. Firstly, that palliative care should be offered to everyone suffering from a terminal illness and, secondly, that this approach encompasses not just physical, but also psychological and social needs of the patient and the family. These findings will help inform the establishment of a palliative care program that fills the gaps in comprehension and knowledge of caregivers.

Assessment of cancer pain management knowledge in southwest China: a survey of 259 physicians from small city and county hospitals

BACKGROUND

Pain management is a critical issue in the care of cancer patients in China, especially in small city and county hospitals in southwest China.

OBJECTIVE

The study intended to determine Chinese physicians' competence in cancer pain management and to assess their opinions on barriers to optimal pain management.

DESIGN

A questionnaire on pain management was given to 259 fellows after their general orientation meeting at a tertiary teaching hospital. The questionnaire was adapted from an earlier study by the Eastern Cooperative Oncology Group (ECOG).

RESULTS

The majority of the fellows believed that 70% of cancer patients suffer pain. Nearly 90% (224/259) indicated that their training in cancer pain management was poor. The fellows stated that concern about morphine addiction was the primary reason they hesitated to prescribe opioids, and they identified inadequate assessment of cancer pain as the most significant barrier to optimal management of cancer pain.

CONCLUSION

The study reflects to some extent the state of pain management in hospitals in southwest China. Medical students and physicians in China need improved pain management education.

Palliative care education in China: insight into one medical university

CONTEXT

There has been an increase in the amount of palliative care available in developing countries, including in China. However, palliative care is still very limited, and it is not mandatory to teach courses on palliative care in Chinese medical universities.

OBJECTIVES

To assess Chinese interns' awareness of palliative care concepts.

METHODS

Using a questionnaire selected from an earlier Austrian study, interns in a Chinese medical university were surveyed. All those surveyed had already been interns for at least six months.

RESULTS

Four hundred interns from a Chinese medical university (response rate 99.5%) were surveyed. Twenty-one percent were female (84 of 400), and the average age was 23 years. Approximately one-third (34.5%) of interns were familiar with the pain scale, and 31% of interns were familiar with the concept of pain management. Only 7.5% of interns felt adequately trained in basic pain management, and 13% felt adequately trained to manage symptoms of dying patients. Seventy-seven percent of interns reported inadequate education regarding discussion of death with patients and family members. More than 80% of interns felt that more education about palliative care should be included in the basic medical curriculum and clinical intern training.

CONCLUSION

Palliative care education is inadequate from the perspective of the Chinese medical interns. An improvement in the medical school curriculum is needed.

Action research: developing a pediatric cancer pain program in jordan

Children's pain is undertreated worldwide. Using a model of pediatric cancer pain management in Amman, Jordan, the authors demonstrated that an action research approach to pain service development resulted in a sustainable program of pain control. Barriers to care were due more often to health professionals' misconceptions concerning pain and opioid use than to concerns related to cultural, religious, or societal beliefs. Successful implementation of a pain management program requires education, policy development, and support from several levels of hospital administration. Role-modeling and mentorship are important factors. Established knowledge translation theories explained some but not all of the findings. Outcomes included consistent pain assessment and documentation by nursing staff, increased consultation for pain management, and increased use of intravenous opioids.