Self-confidence and knowledge of German ICU physicians in palliative care - a multicentre prospective study.
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ABSTRACT: Little is known about ICU physicians' self-confidence and knowledge related to palliative care. Our objective was to investigate self-confidence and knowledge of German ICU physicians related to palliative care, and to assess the impact of work experience, gender, specialty and additional certifications in pain or palliative medicine.In a multicentre prospective observational study ICU physicians of ten hospitals were asked to rate their self-confidence and to complete a multiple choice questionnaire for the assessment of knowledge. Beyond descriptive statistics and non-parametric tests for group comparisons, linear regression analysis was used to assess the impact of independent variable on self-confidence and knowledge. Spearman's rank test was calculated.55% of answers in the knowledge test were correct and more than half of the participants rated themselves as "rather confident" or "confident". Linear regression analysis revealed that an additional certificate in either pain or palliative medicine significantly increased both knowledge and self-confidence, but only 15 out of 137 participants had at least one of those certificates. Relation between self-confidence and the results of the knowledge test was weak (r?=?0.270 in female) and very weak (r?=?-0.007 in male).Although the questionnaire needs improvement according to the item analysis, it appears that, with respect to palliative care, ICU Physicians' self-confidence is not related to their knowledge. An additional certificate in either pain or palliative medicine was positively correlated to both self-confidence and knowledge. However, only a minority of the participants were qualified through such a certificate.
<h4>Background</h4>Little is known about ICU physicians' self-confidence and knowledge related to palliative care. Our objective was to investigate self-confidence and knowledge of German ICU physicians related to palliative care, and to assess the impact of work experience, gender, specialty and additional certifications in pain or palliative medicine.<h4>Methods</h4>In a multicentre prospective observational study ICU physicians of ten hospitals were asked to rate their self-confidence and to ...[more]
Project description:Patients with life-limiting or palliative illnesses represent a challenge for emergency departments because, despite the growing availability of specialized outpatient palliative care resources at home, patients often present during symptom exacerbations or when family caregivers become overwhelmed. Also, as life-limiting illnesses are frequently first diagnosed there and treatment goals are adjusted, it appears advantageous to establish early connections between emergency patients with palliative needs and palliative care resources. The objective of this study was to conduct a survey evaluating the availability of fundamental palliative care knowledge and palliative care structures in clinical acute and emergency medicine. For this purpose, an online survey was distributed via emergency medicine blogs, targeting physicians working in emergency departments. In total, 383 fully completed questionnaires were analyzed. It was found that the respondents often encounter patients with palliative needs. However, both outpatient and inpatient palliative resources are not universally accessible, and where, for instance, consultation services are available, there is a lack of consensus regarding the appropriate timing for their utilization. Structures for end of life care are largely in place, although time and personnel are often insufficiently available. There is an expressed interest in further education and training in palliative care. In conclusion, as emergency departments serve as the interface between outpatient and inpatient care, an interdisciplinary and holistic approach can be employed to lay the groundwork for ongoing palliative care, benefiting patients with palliative needs.
Project description:PurposeTo systematically review existing literature on knowledge and confidence of primary care physicians (PCPs) in cancer survivorship care.MethodsPubMed, Ovid MEDLINE, CINAHL, Embase, and PsycINFO were searched from inception to July 2022 for quantitative and qualitative studies. Two reviewers independently assessed studies for eligibility and quality. Outcomes were characterized by domains of quality cancer survivorship care.ResultsThirty-three papers were included, representing 28 unique studies; 22 cross-sectional surveys, 8 qualitative, and 3 mixed-methods studies. Most studies were conducted in North America (n = 23) and Europe (n = 8). For surveys, sample sizes ranged between 29 and 1124 PCPs. Knowledge and confidence in management of physical (n = 19) and psychosocial effects (n = 12), and surveillance for recurrences (n = 14) were described most often. Generally, a greater proportion of PCPs reported confidence in managing psychosocial effects (24-47% of PCPs, n= 5 studies) than physical effects (10-37%, n = 8). PCPs generally thought they had the necessary knowledge to detect recurrences (62-78%, n = 5), but reported limited confidence to do so (6-40%, n = 5). There was a commonly perceived need for education on long-term and late physical effects (n = 6), and cancer surveillance guidelines (n = 9).ConclusionsPCPs' knowledge and confidence in cancer survivorship care varies across care domains. Suboptimal outcomes were identified in managing physical effects and recurrences after cancer.Implications for cancer survivorsThese results provide insights into the potential role of PCPs in cancer survivorship care, medical education, and development of targeted interventions.
Project description:Background: Patients in low-income and middle-income countries (LMICs) have limited access to palliative care providers. In Myanmar, little is known about physician knowledge of or perceptions about palliative care. An assessment of physician practice and capacity to provide palliative care is needed. Objective: Our objective was to identify physician practice patterns, knowledge gaps, and confidence in providing palliative and end-of-life care in Myanmar. Design: This was a cross-sectional survey study. Setting/Subjects: Participants were physicians practicing in Myanmar who attended the Myanmar Emergency Medicine Updates Symposium on November 10 to 11, 2018 in Yangon, Myanmar (n = 89). Measurements: The survey used modified Likert scales to explore four aspects of palliative care practice and training: frequency of patient encounters, confidence in skills, previous training, and perceived importance of formal training. Results: Study participants were young (median age 27 years old); 89% cared for terminally ill patients monthly, yet 94% reported less than two weeks of training in common palliative care domains. Lack of training significantly correlated with lack of confidence in providing care. Priorities for improving palliative care services in Myanmar include better provider training and medication access. Conclusions: Despite limited training and low confidence in providing palliative care, physicians in Myanmar are treating patients with palliative needs on a monthly basis. Future palliative care education and advocacy in Myanmar and other LMICs could focus on physician training to improve end-of-life care, increase physician confidence, and reduce barriers to medication access.
Project description:BackgroundDementia is a global public health priority. The World Health Organization adopted a Global Action Plan on Dementia, with dementia awareness a priority. This study examined the knowledge, attitudes, and self-confidence with skills required for providing dementia care among primary health care providers in Vietnam.MethodsA cross-sectional study was conducted with 405 primary health care providers who worked at commune health stations and district health centers in eight provinces across Vietnam.ResultsThe results showed that primary health care providers had poor knowledge and little confidence but more positive attitudes toward dementia care and management.ConclusionsThe results suggest the training needs for building capacity amongst primary health care providers, which will be critical as Vietnam's population ages.
Project description:BackgroundOver the past five decades, palliative care has changed from helping patients at the end of life into a highly dedicated service focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. To date there is no common agreement on universally applicable measurement tool to know the areas of weakness in physicians' understanding of palliative care and identifying misconceptions about palliative care. This paper describes the development of a reliable and valid questionnaire to provide a measure of the attitude and knowledge of physicians toward palliative care (PCAK).MethodsItem pool was generated paying particular attention to content and face validity. The initial version of the questionnaire was piloted and assessed based on psychometric criteria. Items which did not reach acceptable validity were excluded, and the final 37 item version was administered to two groups differing in their palliative care attitude and knowledge on two occasions to assess the construct validity and test-retest reliability. Two hundred thirty two physicians working in primary care clinics and general hospitals completed the questionnaire at the piloting stage. The final version (PCAK) was administered to 35 oncologists and 76 physicians. SPSS v20 was used for statistical analysis.ResultsOf the Pilot study, 20 items were excluded because didn't meet the criteria for item difficulty and discrimination. Item-to-total-score correlations (r) was ranging from 0.347 up to 0.806. Internal consistency (Cronbach's alpha) was high ranging from 0.636 to 0.824. While testing the final PCAK, oncologist scored consistently higher than the other physicians on all sections of the questionnaire (P < 0.001) suggesting good construct validity. Test to retest reliability for each section was very high, ranging from 0.879 to 0.97 and the overall reliability was 0.95. The internal consistency reliability of each section was very good ranging from 0.681 ± 0.893.ConclusionThe findings demonstrate that PCAK meets psychometric criteria for reliability and construct validity. It provides a useful scale to assess the attitude and knowledge of physicians about palliative care helping in planning of educational programs for physicians.
Project description:IntroductionPalliative care is still a new concept in many developing countries like Bangladesh. Basic knowledge about palliative care is needed for all physicians to identify and provide this care. This study aims to assess the preliminary knowledge level and the misconceptions about this field among physicians.MethodsThis cross-sectional study was conducted among 479 physicians using a self-administered structured questionnaire adapted from Palliative Care Knowledge Scale (PaCKs) on various digital social media platforms from December 2019 to February 2020. Chi-square, Fisher's extract test, and the Monte Carlo extract test was done to compare the knowledge level with the study subjects' demographic variables.ResultsAn almost equal number of physicians of both genders from four major specialties and their allied branches took part in the study (response rate 23.9%). The majority (71%) of the respondents had an average to an excellent level of knowledge about palliative care, with a median score of 11.0. Although most physicians had average knowledge about the primary goals and general concepts of palliative care, misconceptions are highly prevalent. The commonly present misconceptions were that palliative care discourages patients from consulting other specialties (88.9%), refrains them from taking curative treatments (83.1%), and this care is only for older adults (74.5%), cancer patients (63%), and the last six months of life (56.4%). Age, educational qualifications, and specialties had significant relationships (P<0.05) with the level of knowledge.ConclusionDespite having average or above knowledge about palliative care, the physicians' prevailing misconceptions act as a barrier to recognizing the need among the target populations. So, proper education and awareness among the physicians are necessary to cross this field's barrier and development.
Project description:BackgroundPediatric palliative care (PPC) helps maintain the quality of life for both children and their families. It has been identified as an important goal within the global health agenda. In Saudi Arabia, the discipline remains in its infancy, as illustrated by the absence of PPC programs in academic and health care institutions.AimThe aim was to conduct a pilot study assessing physicians' knowledge, attitudes, and perceptions toward PPC.MethodData were gathered through a self-administered questionnaire sent to physicians working in Saudi Arabia.ResultsOne hundred twelve completed the survey (male 54.2%, n = 50). A total of 40.8% (n = 42) had 20 years or more of experience, 42.9% (n = 48) were from the hematology-oncology specialty, and 68.5% (n = 74) received no training in PPC. Half suggested that children should be informed of their condition but mostly when reaching 12 or 15 years of age. Various physicians reported that the most appropriate time to discuss a transition to palliative care goals is when diagnosing an incurable condition or when despite all efforts, a condition continues to progress and death is expected.ConclusionMultiple gaps were identified. PPC basic concepts should be included in the formal medical curriculum (e.g., pain management, communication, and ethical considerations at the end of life). There is also a significant need to develop further both primary and specialized palliative care.
Project description:Background: The worldwide need for palliative care is high, especially in mid- income countries like Ecuador, where the percentage of patients receiving such care is very small due to the scarcity of infrastructure and specialized personnel and to the unequal distribution in the country. The objective of this study is to explore the knowledge, attitudes and expectations related to palliative care of the physicians in Ecuador. Methods: A qualitative study based on 28 semi-structured interviews, from March 2014 to November 2016, with physicians working in four cities in Ecuador recruited through the snowball technique. Thematic analysis was developed supported by the ATLAS.ti software. Results: Five core themes were identified: (1) training, (2) health policy, (3) professionals' activities, (4) health services and (5) development of palliative care in Ecuador. Conclusions: Strategies are needed which intensify the training of medical professional in palliative care, as well as avail the human resources and materials for providing it.
Project description:IntroductionDespite continuously growing, palliative care in Thailand still needs further development. Many family physicians provide various levels of palliative care. However, there is no information regarding what aspects of palliative care family practitioners provide and how much confidence they have. This study aims to identify gaps between expected care domains and provided care and to reveal the domains in which family physicians are less confident.MethodThis study is a cross-sectional survey study. An online questionnaire was publicly published to recruit target participants, Thai family physicians who have received formal residency training and actively practice medicine. The estimated number of actively practising family physicians was 540 persons. Participants were asked which palliative care domains they provide and to rate their confidence in each. A narrative analysis was performed using two relevant frameworks.ResultOne hundred and seven responses were received. Forty-six per cent of participants have no further training in palliative care other than during their residency programs. At least 63.6 per cent of participants provide palliative care two half-day per week or less. Grief and spiritual care enjoyed the least percentage of the participant's responses regarding provided care. These two domains also received the lowest percentage of confidence in providing care from the participants.DiscussionThough they are considered essential domains, there are gaps between expected care and actual care in grief management and spiritual care. Grief and bereavement care are mentioned in the residency curriculum; nonetheless, there is an inconsistency regarding spiritual care. Increasing access to continuous education and integrating it into curriculums should be considered to reduce the gaps. Additionally, a national guideline regarding levels of palliative care and the roles of family physicians will benefit from establishing comprehensive palliative care programmes.
