Assessing palliative care education in undergraduate medical students: translation and validation of the Self-Efficacy in Palliative Care and Thanatophobia Scales for Brazilian Portuguese

Challenges in Palliative Care in Latin America: A Narrative Review

In "graying" populations with extended lifespans and survivable forms of cancer, palliative services become increasingly important but may be difficult to introduce into public discourse, public policy, and healthcare systems. Latin America (LATAM) faces many challenges as it introduces and, in some cases, develops its palliative care programs; though the challenges faced here are in many ways universal ones, LATAM approaches may be unique and based on the region's specific culture, politics, and economics. This narrative review based on a literature search identified 10 main themes that can be interpreted as challenges and opportunities for palliative care in LATAM. These challenges are integrating palliation into healthcare systems; public policy and funding; therapeutic obstinacy; changing demographics; access to services; analgesia; the role of religion, spirituality, and folk medicine; social determinants of palliative care; low health literacy; and limited clinician training. Some of the LATAM nations have palliative programs and palliative care training in place while others are developing these systems. Integrating this care into existing healthcare and reimbursement systems has been a challenge. A notable challenge in LATAM is also access to care since palliative programs tend to cluster in metropolitan areas and create hardships for rural citizens to access them. The better-defined role of familial caregivers and telehealth may be important factors in the expansion of palliative care in LATAM and beyond.

Instruments to measure skills and knowledge of physicians and medical students in palliative care: A systematic review of psychometric properties

PURPOSE

Palliative care is constantly increasing around the world. The knowledge and skills of future physicians in this area are crucial. This study evaluates the psychometric properties of knowledge and skills questionnaires used in palliative care, validated by physicians or medical students based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

METHODS

A systematic review was carried out in Cosmin Databases, Cochrane Library, PsycINFO, SciELO, Cinahl, and Medline up to September 2020 (updated June 2021), based on the COSMIN methodology and PRISMA recommendations. The psychometric properties of each included questionnaire were identified. Methodological quality, quality of results, and quality of evidence were evaluated.

RESULTS

The search strategy yielded 12 questionnaires assessing the knowledge and skills of physicians or medical students. The Palliative Care Knowledge Questionnaire for PEACE (PEACE-Q) and Palliative Care Knowledge Test (PCKT) were the instruments with the highest scores for methodological quality, quality of results, and quality of evidence-based on the COSMIN methodology.

CONCLUSIONS

PEACE-Q and PCKT should be the preferred choice to assess palliative care knowledge and skills in physicians. In-depth studies following COSMIN validation criteria are recommended to improve the psychometric properties and cross-cultural validation of the questionnaires.

Translation, adaptation, and validation of the Self-efficacy in Palliative Care scale (SEPC) for use in Swedish healthcare settings

Background

One challenge for healthcare professionals when delivering palliative care can be their lack of confidence. The Self-efficacy in Palliative Care Scale (SEPC) is considered a valid and reliable assessment scale to evaluate confidence when delivering palliative care. Currently, there is not a reliable instrument aimed to measure healthcare professionals’ confidence in palliative care in Swedish. Therefore, this study aimed to translate, culturally adapt, and validate the SEPC-scale for use in a Swedish healthcare context.

Methods

This study applied the World Health Organization’s (WHO) guidelines for translating and adapting instruments, using forward and back-translation, an expert panel, and cognitive interviews. Swedish experts in palliative care (n = 6) assessed the Swedish version of the SEPC-scale based on its relevance, understandability, clarity, and sensitivity on a Likert scale. Methods involved calculation of content validity index (CVI) with modified kappa statistics and cognitive interviewing with healthcare professionals (n = 10) according to the “think-aloud” method.

Results

Calculation of I-CVI (Item-CVI) showed that the Swedish SEPC-scale was considered relevant but needed some modifications to improve its understandability and clarity. The experts recognized an absence of precision in some items that affected clarity and understanding. Likewise, the healthcare professionals highlighted some challenges with understandability and clarity. They indicated that the scale was relevant, but a few items needed adjustment to fit a broader range of healthcare professionals. Items that referred to death and dying could be sensitive but were considered relevant.

Conclusions

The SEPC-scale is considered valid for use in Swedish healthcare practice, for a broad range of healthcare professionals, and for diagnoses other than cancer. This study shows that cultural adaptation is necessary for establishing relevance and enabling acceptance to various healthcare professionals and contexts in the target country.

Examining the effect of non-specialised clinical rotations upon medical students' Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools

INTRODUCTION

Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback.

OBJECTIVE

Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools.

DESIGN

Observational prospective study.

SETTING

Medical schools in Brazil.

PARTICIPANTS

134 sixth-year medical students of two medical schools.

METHODS

This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches.

PRIMARY OUTCOMES

SEPC and TS Scales were used to assess students at the beginning and the end of the rotations.

RESULTS

In both schools' students had an increase in SEPC and a decrease in TS scores.

CONCLUSION

Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.