Development of palliative care attitude and knowledge (PCAK) questionnaire for physicians in Kuwait

Rasch analysis of the perceptions of palliative care instrument (PPCI) in patients with advanced cancer

RATIONALE, AIMS, AND OBJECTIVES

The Perceptions of Palliative Care Instrument (PPCI) is a tool used to access perceptions towards palliative care in patients with advanced cancer. However, its psychometric properties have not been widely tested using modern psychometric methods. This study aimed to examine the psychometric properties of the PPCI in patients with advanced cancer using Rasch analysis.

METHODS

Four hundred and forty four Participants were recruited from the Department of Medical Oncology at a tertiary care hospital in Xinxiang City, Henan Province, China, between October 2020 and February 2021. Participants completed the PPCI. Rasch analysis procedures were conducted, including assessment of unidimensionality, model-date fit, rating scale function, differential item functioning, item-person map, and person and item reliability.

RESULTS

The unidimensionality of the PPCI was confirmed, although two items (18 and 21) did not fit the Rasch model. The degree of fit of each item to its respective dimension was excellent, with Infit MNSQ and Outfit MNSQ values ranging from 0.73 to 1.33. The PPCI demonstrated high reliability, with an item reliability of 0.99 and a person reliability of 0.77.

CONCLUSION

The PPCI is a valid and reliable instrument for assessing perceptions of palliative care in advanced cancer patients. However, to further improve the quality and applicability of the PPCI, the deletion of items 18 and 21 is recommended, as they did not fit the Rasch model.

Doctors' knowledge, attitudes and practices of palliative care in two South African districts

BACKGROUND

 In South Africa, most palliative care takes place in health districts as part of home-based care provided by nongovernment organisations (NGOs). The National Policy Framework and Strategy on Palliative Care (NPFSPC) aims to ensure adequate numbers of palliative care trained healthcare workers. Guidelines and tools such as the Supportive and Palliative Care Indicators Tool (SPICT) assist in identifying and caring for patients needing palliative care.

AIM

 To evaluate the knowledge, attitudes and practices of public sector doctors to provide palliative care in the Garden Route and Central Karoo Districts.

SETTING

 The study was conducted at public sector district-level hospitals.

METHODS

 A descriptive observational cross-sectional survey was conducted. The study population included all public sector district-level doctors. Participation was voluntary, and 73 responses (60%) were obtained. Data were collected with an online questionnaire using the adapted 'Knowledge Attitudes Practice' model. Quantitative data were imported into the Statistical Package for Social Sciences for analysis.

RESULTS

 Participants had poor knowledge, attitudes and practices regarding palliative care. There was a statistically significant difference between the knowledge of junior doctors and senior doctors, with 78% of junior doctors having inadequate palliative care knowledge. Only 25% of respondents had received formal postgraduate palliative care training. Seventy (96%) participants reported that home was the best care setting for terminally ill patients.

CONCLUSION

 Doctors in the Garden Route and Central Karoo need further training to meet the NPFSPC standards.Contribution: This study adds to the palliative care field, highlighting the need for ongoing training of doctors.

Validation of Two Questionnaires Assessing Nurses' Perspectives on Addressing Psychological, Social, and Spiritual Challenges in Palliative Care Patients

BACKGROUND

Palliative care provides holistic support, addressing physical, psychological, social, emotional, and spiritual dimensions of suffering, known as "total pain", to improve patients' quality of life. Patients often rely on healthcare professionals, particularly nurses, for support. This study aimed to develop and validate questionnaires assessing nurses' perceptions of psychological, social, and spiritual issues in palliative care and their effectiveness in managing them.

METHODS

Two self-rated questionnaires were created: the Psychological, Social, and Spiritual Problems of Palliative Patients' Questionnaire and the Effectiveness in Coping with the Psychological, Social, and Spiritual Challenges of Palliative Care Patients. The study surveyed 237 nurses caring for palliative patients in Split Dalmatian County, Croatia.

RESULTS

The questionnaires demonstrated high reliability with Cronbach's α values of 0.98 and 0.99. Factor analysis revealed four factors for the first questionnaire and three for the second. Nurses primarily perceived patients as experiencing fear and emotional/spiritual suffering, with the greatest difficulty coping with the fear of the disease outcomes. Nurses acknowledged the need for improvement in addressing patient challenges, highlighting gaps in the Croatian system.

CONCLUSIONS

Ongoing efforts are crucial to prioritize palliative care globally, with nursing professionals playing a vital role in symptom management.

Palliative care in the emergency department: An observational study of doctors in KwaZulu-Natal

BACKGROUND

 The World Health Organization advocates the early, appropriate provision of palliative care (PC) to patients throughout the life course. Patient consultations to the emergency department (ED) have been recognised as opportunities to initiate or optimise their PC needs. This study aimed to assess the knowledge of and attitudes towards PC among doctors at emergency physician staffed EDs in KwaZulu-Natal, South Africa.

METHODS

 A cross-sectional survey was conducted between November 2021 and February 2022 for doctors employed out at emergency physician staffed EDs in KwaZulu-Natal, South Africa, using the validated Palliative Care Attitude and Knowledge questionnaire. The variables assessed were the self-rated and basic knowledge and attitudes towards core domains of PC. Ordinal data were compared using the t-test or ANOVA as appropriate, using MedCalc® Statistical Software version 22.009.

RESULTS

 Of the 39 participants, the scores for the knowledge questions showed that 15.3% participants had good knowledge, 53.8% had fair knowledge and 30.7% had poor knowledge. Participants had either favourable (58.8%) or an uncertain (41.0%) attitude towards PC. No correlation was seen between the knowledge and attitudes scores (Spearman's rho = 0.13, 95% CI -0.19 to 0.43, p = 0.43).

CONCLUSION

 There appears to be a deficit in knowledge of PC among doctors in the ED and a need for in-service training in PC for emergency care physicians.Contribution: This study provides new knowledge around PC practices at EDs in KwaZulu-Natal, South Africa.

Status and predictors of medical students' knowledge and attitude towards palliative care in Jordan: a cross-sectional study

BACKGROUND

Palliative care focuses on the ability of medical students to use their expanded experiences and knowledge; however, basic medical education does not provide adequate knowledge and skills regarding palliative and end-of-life care. This study designed to examine knowledge related to palliative care and attitudes toward dying people among medical students in Jordan.

METHODS

Cross-sectional, descriptive design was used in this study. A total of 404 medical students were recruited using convenience sampling techniques from six medical programs. Data was collected using a self-administered questionnaire in relation to knowledge and attitudes regarding palliative care and dying persons using Palliative Care Assessment Knowledge (PCAK) and Frommelt Attitudes toward Care of the Dying Scale Form B (FATCOD-B).

RESULTS

Medical students have a moderate level of knowledge related to palliative care in (PCAK) part1 subscale about; pain managing (n = 156, 38.6 %), managing other palliative care symptoms (n = 164, 40.6 %), and in witnesses' family counseling and breaking bad news discussion (n = 178, 44.1 %). However, medical students have inadequate knowledge concerning the palliative care in part-2of the scale. Furthermore, students have positive attitudes towards caring for dying patients with mean score of 108.76 (SD = 8.05). The highest ranked attitude subscales were; Fairs/Malaise (M = 29.03, SD = 4.28), Communication (M = 21.39, SD = 2.51) and Relationship (M = 18.31, SD = 1.55). There was a significant difference in attitudes in relation to gender (t = -5.14, p < 0.001) with higher female mean score (M = 109.97) than males (M = 105.47). Also significant difference found among those who are exposed to Palliative Care and those who are not (t = -6.33, p < 0.001) with higher mean score of those exposed to palliative acre courses (M=298) than those who did not (M=106).

CONCLUSION

Improving knowledge and attitudes of medical students regarding palliative and end of life care should be highlighted to medical educators and medical schools need to incorporate palliative and end-of-life care into medical curricula across all levels.

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.

The development of a questionnaire to assess the willingness of Chinese community health workers to implement advance care planning

Background

To develop a questionnaire to evaluate the willingness of Chinese health care workers to implement an advance care planning (ACP) program for patients in a Chinese cultural context.

Methods

Guided by the framework of the theory of planned behavior (TPB), a literature analysis and semi-structured interviews were conducted to create a pool of questionnaire items, and then the initial assessment questionnaire was developed by two rounds of expert consultations. A random sampling method was used to pre-survey 204 health care workers in community health service centers (CHSCs) in three urban areas of Hangzhou, Zhejiang Province. The final questionnaire was derived from item analysis and exploratory factor analysis.

Results

Based on exploratory factor analysis, five common factors were identified from the questionnaire on community health care workers‘(CHWs) willingness to implement ACP. In general, the content validity of the questionnaire was 0.91, and the content validity of each of the entries ranged from 0.80 to 1.00, indicating acceptable overall questionnaire content validity. The total Cronbach coefficient for the questionnaire was 0.966, the Cronbach coefficient for each dimension ranged from 0.865 to 0.954, and the retest reliability was 0.856. The questionnaire produced a final draft containing five dimensions (behavioral attitudes, subjective norms, direct control, indirect control, and behavioral intentions) and 30 items.

Conclusion

The questionnaire on the willingness of CHWs to implement ACP was validated and found to be reliable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01046-8.

Attitude and Associated Factors Toward end of Life Care among Nurses Working in Kuwait Hospitals: A Cross-sectional Study

Objective:

The current study assessed the attitude toward end of life (EOL) care among nurses working in Kuwait hospitals.

Material and Methods:

A descriptive, cross-sectional design was used to recruit 900 nurses from nine public, private and military hospitals in Kuwait. Data were collected using a self-administered questionnaire of the Frommelt Attitude Toward the Care of Dying questionnaire.

Results:

The results showed that nurses in Kuwait had a favourable and supportive attitude towards EOL care, mainly toward the families’ need for emotional support, care for the dying patients, involving the family in care, and accepting death. Further, attitude scores differed significantly based on nurses’ age, year of experience, education level, nationality, type of hospital, and place of work.

Conclusion:

Nurses working in Kuwait have a favourable attitude toward care for dying patients but an unfavourable perception toward making conversation with patients about death. Hence, providing appropriate awareness to nurses about death and dying in Kuwait might be a promising intervention to improve their attitude and sensitise the concept of death among them.

The Palliative Care Knowledge Questionnaire-Basic (PCKQ-B): Development and Validation of a Tool to Measure Knowledge of Health Professionals about Palliative Care in India

Objectives:

A well-educated and aware staff are the needed to overcome barriers to palliative care provision in the face of ever-increasing needs of palliative care in developing countries like India. Lack of a standardised and locally validated need assessment tool is felt as one of the important requirements for any successful educational program. This project is to develop and validate a basic palliative care knowledge needs assessment questionnaire.

Materials and Methods:

Development of Palliative Care Knowledge Questionnaire-Basic (PCKQ-B) for Indian nurses working in a tertiary care hospital in Delhi-NCR, India was undertaken with four basic processes, that is, item generation, content validity, pilot testing and field testing. Literature search helped us to find appropriate domains and items; content validity obtained with a panel of seven experts, pilot testing and finally field testing was done on 102 nurses working in 6 branches of Max Super Specialty Hospital, Delhi-NCR, India. The field study data were used to do item analyses including item difficulty, item discrimination and calculate reliability indicators including test-retest correlation and KR-20.

Results:

Content Validity index (CVI) of all the items was >0.78 (except 1 item) and Scale-CVI was 0.98 (excellent content validity). Items were selected on the basis of item difficulty index of 0.1 to 0.9 and an item discrimination index greater than 0.2. A total of 25 questions were selected that elicited KR-20 value of 0.65 and intra class correlation (test-retest reliability) of 0.52.

Conclusion:

Overall, PCKQ-B is a 25 item questionnaire with a moderate reliability. Although validated for nurses in tertiary care hospitals, this tool might find utility in education of primary health workers, community health workers, social workers, or physiotherapists in palliative care teams.

Design and Validation of the INCUE Questionnaire: Assessment of Primary Healthcare Nurses' Basic Training Needs in Palliative Care

Many instruments have been created to measure knowledge and attitudes in palliative care. However, not only is it important to acquire knowledge, but also that this knowledge should reach patients and their relatives through application in clinical practice. This study aimed to develop and psychometrically test the INCUE questionnaire (Investigación Cuidados Enfermeros/Investigation into Nurses’ Care Understanding of End-of-Life) to assess the basic training needs of primary or home healthcare nurses in palliative care. A questionnaire was developed based on the classical theory of tests and factor analysis models. Initially, 18 experts developed 67 items in two blocks and determined content validity by two rounds of expert panels. Exploratory factor analysis and reliability testing were conducted with a non-probabilistic sample of 370 nurses. Some items were observed to have very low homogeneity indices or presented convergence problems and were eliminated. Questionnaire reliability was 0.700 in the theoretical block (KR20 Index) and 0.941 in the practical block (Cronbach’s alpha). The model converges and shows an adequate fit, specifically CFI = 0.977, TLI = 0.977 and RMSEA = 0.05. The correlation between the two factors in the model is ρ = 0.63. The questionnaire objectively evaluates primary or home healthcare nurses’ knowledge of palliative care and its practical application, thereby facilitating more efficient training plans.

Examining the role of specialist palliative care in geriatric care to inform collaborations: a survey on the knowledge, practice and attitudes of geriatricians in providing palliative care

BACKGROUND

The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant.

AIM

To examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services. We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care.

DESIGN

A prospective cross-sectional study surveying Australasian geriatricians was conducted.

SETTING/PARTICIPANTS

This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine.

RESULTS

A total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience. Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in a Modified Palliative Care Knowledge Test.

CONCLUSIONS

Geriatricians find reward in providing generalist palliative care to their patients; however, potential exists for improved collaborations with specialist palliative care services. An evidence base for geriatric patients who benefit most from specialist palliative care services is needed to improve resourcing, collaborative practice and ultimately palliative care delivery.

Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models

The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)^®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.

Palliative Care Quiz for Nurses-Indonesian Version (PCQN-I): A Cross-cultural Adaptation, Validity, and Reliability Study

Aim

The study is aimed to perform a cross-cultural adaptation of the palliative care quiz for nurses in an Indonesian context to evaluate its psychometric properties.

Methods

A two-phase design was used in this study, including cross-cultural adaptation and psychometric testing. The PCQN-I was tested on a convenience sample of health-care providers recruited from 20 primary health-care (PHC) centers in Yogyakarta, Indonesia, from July to October 2017.

Results

The cross-cultural adaptation ultimately resulted in a total of 20 items from the PCQN-I. An expert committee revised the words in Item 4 from "adjuvant therapies" to "adjuvant therapies/additional therapies," in Item 5 from "bowel regimen" to "gastrointestinal therapies," and Item 16 from "Demerol" to "Pethidine" based on the Indonesian context. The experts retained Item 5 "It is crucial for family members to remain at the bedside until death occurs," although none of the participants (n = 40) involved in the pilot testing could answer it correctly, and Item 19 "The loss of a distant or contentious relationship is easier to resolve than the loss of one that is close or intimate" although few participants responded correctly. A total of 150 health-care providers consisting of 100 nurses and 50 physicians were involved in the psychometric testing. The scale-level content validity index/Ave of the PCQN-I was 97 and 93 in terms of its relevancy and clarity, respectively. The reliability was calculated as the Kuder-Richardson formula 20 score was 0.71.

Conclusions

The PCQN-I is a valid and reliable instrument for assessing palliative care knowledge among PHC providers. Further research is warranted to examine its reliability in different clinical settings.

Harmonising palliative care: a national survey to evaluate the knowledge and attitude of emergency physicians towards palliative care in Kuwait

BACKGROUND AND AIM

Although the challenges of integrating palliative care practices across care settings are real and well recognised, to date little is known about palliative care practices of emergency physicians (EPs) in Kuwait. Therefore, this study aims to explore the attitude and knowledge of EPs in providing palliative care in all general hospitals in Kuwait.

METHOD

A cross-sectional survey was performed in the emergency rooms of all general hospitals in Kuwait using the Palliative Care Attitude and Knowledge Questionnaire.

RESULTS

Of the total number of physicians working in emergency rooms (n=156), 104 (66.67%) had completed the survey. 76.9% (n=80) of the EPs had an uncertain attitude towards palliative care. Most of the EPs (n=73, 70.28%) did not discuss the patients' need for palliative care either with the patients or with their families. Only 16 (15.4%) of the EPs responded correctly to most of the questions while nearly half of the EPs (n=51, 49%) had poor knowledge. Experience ≥11 years and better knowledge scores were independent predictors of positive attitude after adjustment of age, sex, qualifications, specialty, position and nationality (OR: 5.747 (CI 1.031 to 25.00), 1.458(CI 1.148 to 1.851); p values: 0.021, 0.002, respectively).

CONCLUSIONS

Despite recognising palliative care as an important competence, the majority of the EPs in Kuwait had uncertain attitude and poor knowledge towards palliative care. Efforts should be made to enhance physician training and provide palliative care resources to improve the quality of care given to patients visiting emergency departments.

Palliative care knowledge test for nurses and physicians: validation and cross-cultural adaptation

Background

Palliative care knowledge is essential in primary healthcare due to the increasing number of patients who require attention in the final stage of their life. Health professionals (physicians and nurses) need to acquire specific knowledge and abilities to provide high-quality palliative care. The development of education programmes in palliative care is necessary. The Palliative Care Knowledge Test (PCKT) is a questionnaire that evaluates the basic knowledge about palliative care, but it has not been adapted into Spanish, and its effectiveness and utility for Spanish culture have not been analysed.

Objective

The aim of this study was to report the translation into Spanish and a psychometric analysis of the PCKT.

Methods

The questionnaire survey was validated with a group of 561 physicians and nurses. The PCKT Spanish Version (PCKT-SV) was obtained from a process, including translation, back translation and revision by experts and a pilot study. The content validity and reliability of the questionnaire were analysed.

Results

The results showed internal consistency and reliability indexes similar to those obtained by the original version of PCKT.

Conclusion

The PCKT-SV is a useful instrument for measuring Spanish-speaking physician and nurse knowledge of palliative care, and it is suitable to evaluate the effectiveness of training activities in palliative care.

Harmonizing Palliative Care: National Survey to Evaluate the Knowledge and Attitude of Emergency Physicians towards Palliative Care.. [DOI: 10.1101/19003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background and Aim

Although the challenges of integrating palliative care practices across care settings are real and well recognized until now little is known about palliative care practice of emergency physicians (EPs) and their accessibility to palliative care services in Kuwait. So the aim of this study was to explore the attitude, and knowledge encountered by EPs in providing palliative care in all general hospitals in Kuwait.

Method

A cross-sectional survey was performed in the emergency rooms of all general hospitals in Kuwait using Palliative Care Attitude and Knowledge (PCAK) questionnaire.

Results

Of the total number of physicians working in emergency rooms (n=156), 104 (66.67%) had completed the survey. 76.9% (n=80) of the EPs had either uncertain attitude toward palliative care. Most of the EPs (n=73, 70.28%) didn’t discuss the need of the patients to palliative care either with the patients or their families. Only 16 (15.4%) of the EPs responded correctly to the most of the questions while nearly half of the EPs (n=51, 49%) had poor knowledge especially in the most effective management of refractory dysnea (n=18, 17.3%). Experience ≥ 11yrs and better knowledge scores were independent predictors of positive attitude after adjustment of age, sex, qualifications, specialty, position, and nationality [OR: 5.747 (CI: 1.031-25.00), 1.458(CI: 1.148-1.851); p-value: 0.021, 0.002 respectively]..

Conclusions

Despite recognizing palliative care as an important competence, the majority of the emergency physicians in Kuwait had uncertain attitude and poor knowledge towards palliative care. Lack of knowledge, direct accessibility to palliative care services and lack of support from palliative medicine specialists were the main reasons for uncertain and negative attitude. Efforts should be done to enhance physician training and provide palliative care resources in order to improve the quality of care given to patients visiting emergency departments.

What this paper adds

Studies proved that the emergency room may be a suitable place for early referral of patients who may benefit from palliative care especially old age to prevent upcoming undesired admissions and hospital deaths.

The integration of palliative care concepts and consultation teams into emergency medicine may help to avoid unnecessary and burdensome treatments, tests, and procedures that are not aligned with patients’ goals of care.

Although the challenges of integrating palliative care practices across care settings are real and well recognized until now little is known about palliative care practice of emergency physicians and their accessibility to palliative care services in Kuwait.

Recently, a newly developed tool called Palliative Care Attitude and Knowledge (PCAK) questionnaire was created to assess the attitude and knowledge of non-palliative physicians toward palliative care. So the aim of this study was to explore the attitude, and knowledge encountered by emergency physicians in providing palliative care using PCAK 8 in emergency departments in all general

Studies showed that early palliative care consultation was shown to improve quality of life for cancer patients and may even lengthen their survival.

What this study adds

Despite recognizing palliative care as an important competence, the majority of the emergency physicians in Kuwait had uncertain attitude and poor knowledge towards palliative care. Lack of knowledge, direct accessibility to palliative care services and lack of support from palliative medicine specialists were the main reasons for uncertain and negative attitude.

Efforts should be done to enhance physician training and provide palliative care resources in order to improve the quality of care given to patients visiting emergency departments.