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 Table of Contents 
BRIEF REPORT
Year : 2012  |  Volume : 19  |  Issue : 3  |  Page : 194-197  

Knowledge of the residents at King Abdul-Aziz University Hospital (KAAUH) about palliative care


Department of Family and Community Medicine - Faculty of Medicine - King Abdul Aziz University, Jeddah, Saudi Arabia

Date of Web Publication13-Oct-2012

Correspondence Address:
Sultan H Alamri
Department of Family and Community Medicine - Faculty of Medicine - King Abdul Aziz University, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8229.102321

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   Abstract 

Background: Palliative care is a rapidly growing subspecialty that aims at improving the quality of life and relieving suffering associated with life threatening disease. Despite its rapid growth and huge demand, the knowledge of health care professionals on palliative care remains inadequate. Objective: This study aims to determine the knowledge of residents at King Abdul-Aziz University Hospital (KAAUH) on palliative care. Materials and Methods: Through a cross-sectional design, all residents in the hospital were invited to complete a two-part self-administered questionnaire in June 2010. The first part of the questionnaire included variables describing the socio-demographic characteristics and educational background, and the second part developed by palliative care education initiative at Dalhousie University in Canada in 2000 had 25 items on the knowledge of palliative care. Results : Of the 80 residents 65 (81%) responded, the overwhelming majority of whom were Saudis (92.3%) with an equal representation of males and females. The mean age of the participants was 29.1 ± 2.4 years. Less than one-third (29.2%) indicated that they had previous didactic education on palliative care. The percentage of right answers on items reflecting knowledge on palliative care accounted for 29.9% ± 9.9%. No statistically significant difference was found in the level of knowledge among the residents according to their demographics or graduation and training characteristics. Conclusion: Resident physicians enrolled in postgraduate programs have suboptimal knowledge of basic palliative care. Substantial efforts should be made to incorporate a palliative care module into the theoretical and practical training of medical students and resident physicians.

Keywords: Knowledge, palliative care, residents, Saudi Arabia


How to cite this article:
Alamri SH. Knowledge of the residents at King Abdul-Aziz University Hospital (KAAUH) about palliative care. J Fam Community Med 2012;19:194-7

How to cite this URL:
Alamri SH. Knowledge of the residents at King Abdul-Aziz University Hospital (KAAUH) about palliative care. J Fam Community Med [serial online] 2012 [cited 2020 Oct 24];19:194-7. Available from: https://www.jfcmonline.com/text.asp?2012/19/3/194/102321


   Introduction Top


Palliative care is quite a recent specialty that was revived in 1967. [1] It is defined by the World Health Organization (WHO) as an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. [2] While cancer patients remain the largest group that receives palliative care, it is becoming increasingly recognized that people suffering from chronic, progressive illnesses, which will eventually become terminal require same type of end of life care. [3]

In the course of the development of palliative care, several associations and organizations have been founded around the world and several declarations made. One very important declaration was made at a meeting in Barcelona in 1995, when the European Association for Palliative Care declared that every individual had the right to pain relief, and that palliative care must be provided according to the principle of equity, irrespective of race, gender, social status, national origin, or the ability to pay for services. These recommendations form the thrust of what has become known as the Barcelona Declaration. [4]

The level of palliative care services varies greatly in different countries. Significant progress has been made in some countries especially those with well-developed health systems. However, most countries in the world have a long way to go to improving palliative care for their people. [5] In Saudi Arabia, the palliative care program, started in the early 1990s at King Faisal Specialist Hospital (KFSHRC) in Riyadh, is thought to be the most developed program in the region, and can be considered a regional center of excellence providing palliative care for the entire region. [6]

The Objectives of this study: To determine the knowledge of the residents working in King Abdul-Aziz University Hospital (KAAUH) about palliative care.


   Materials and Methods Top


Through a cross-sectional descriptive study, all residents working in all departments in KAAUH (n = 80) were personally invited to participate in the study. Written permission from the management was obtained before the conduct of the research. The questionnaires were to be distributed to the physicians with a personalized covering letter. All responses were to be kept confidential and were not to be disclosed except for study purposes.

A self-administered questionnaire was used to collect data from the respondents in June 2010.The first of this two-part questionnaire included variables describing socio-demographic characteristics and educational background. The second was developed by a palliative care education initiative at Dalhousie University in Canada in 2000 and comprised 25 items on the knowledge of palliative care. This part required the respondents to choose the single best answer from multiple options. The maximum possible score on the knowledge sub-scale was 25. The questionnaire had been proven to be both valid and reliable. [7] All data were verified by hand and were coded and entered into a personal computer. Statistical Package for the Social Sciences (SPSS), version 16 was used for statistical analysis. The answers on the questions reflecting knowledge of the participants on palliative care were scored by giving 1 score for each correct answer. The total scores were tested for normality, and if distribution was normal, an independent t-test was used to compare two subgroups, and analysis of variance (ANOVA) test used to compare three or more subgroups. P value <0.05 was considered significant throughout the study. Means are presented as ± one standard deviation.


   Results Top


The majority of the respondents were Saudis (92.3%), with nearly equal percentages of males (49.2%) and females (50.8%). The mean age was 29.1 ± 2.4 years, approximately two-thirds (66.2%) of whom had graduated less than 5 years before the study. The majority (70.8%) were graduates of King Abdul-Aziz University (KAU) and endorsed in the residency program. They were either sponsored by the faculty of medicine (36.9%), KAU hospital (26.2%), or by other faculties (36.9%). Only 29.2% of the respondents indicated that they had received previous didactic teaching on palliative care.

The percentage of right answers on palliative care ranged between 0% and 60% with a mean value of 29.9% ± 9.9%. Although one-third of the physicians gave the right answers on the circumstances for increasing the dosage of opioids in colon cancer (35.4%), a much lower percentage (16.9%) knew the appropriate first line drug treatment for opioid induced nausea, and only 13.8% knew about the likelihood of opioid addiction as a result of cancer pain control. A small proportion (13.8%) of participants knew the first drug of choice for daily prophylaxis for constipation when using opioids, and the probable indication for the use of opioids for the treatment of cancer. A small number of physicians (9.2%) knew the primary reason for increasing the dose of opioids in patients with chronic cancer pain. The level of knowledge was highest in areas concerned with the explanation for increased doses of pain medication for terminal cancer patients, the impact of external beam radiotherapy in pain relief for bone metastasis and the appropriate response to the request of the family not to give the patient the 'bad news' to avoid negative psychological effect [Table 1].
Table 1: Responses of the participants to the items reflecting their knowledge about palliative care

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There were no significant differences in the mean knowledge score among participants according to their demographic characteristics. Moreover, it was found that the reported previous education on palliative care was not associated with significant differences in the mean percentage of right answers between those who had previous training (30.4% ± 9.9%) and those who had not (29.1% ± 10.2%). Although residents working in internal medicine departments achieved higher knowledge scores than their colleagues, this difference was not statistically significant with other departments [Table 2].
Table 2: A comparison of achieved percentage of right answers on palliative care among participants in relation to their characteristics

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   Discussion Top


Although the WHO Cancer Unit advocated the use of opioids in the early 1980s as a major intervention for cancer pain relief, [8] our results revealed that the knowledge of our residents regarding opioid use as an important medication in palliative care was generally very low. The overall percentage of right answers recorded from our participants (29.9% ± 9.9%) was considerably low. A similar level of knowledge on palliative care has been documented for physicians in the USA who care for patients with diminished mental capacity who are critically ill. [9] However, a German study using a different questionnaire, indicated a higher percentage of knowledge in prehospital emergency physicians. There were, on the average, 10.8 (43.3%) questions (SD ± 5.7, range 2-24) answered correctly. [10] This variation could be attributed to the differences in the study design, the assessment tools used or the presence of specialized team with better knowledge in palliative care.

Physicians' lack of knowledge on palliative care was discussed in a study conducted in India. The two reasons given are (a) the lack of knowledge about the nature of the end-stage of some clinical cases such as cancer pain and (b) the lack of education, which accounts for the meager knowledge about palliative care. [11]

Our findings revealed that the length of time since graduation had no significant effect on the knowledge scores. These findings are dissimilar from observations made on prehospital emergency physicians in Germany, where it was found that physicians with professional experience of less than 5 years answered statistically significantly more questions correctly. There were two reasons for this. The first is that since the introduction of palliative care in the undergraduate curriculum was recent, those whose experience was less than 5 years had this type of didactic teaching, which had not been available to those who had graduated 5 or more years before. The second reason is the claim that palliative care was not sufficiently covered in the continuous medical education program. Therefore, it was recommended that more attention should be paid to education on pain therapy and end-of-life care. [10]

In a German report, academic training was said to have a positive impact on the knowledge of future physicians about palliative care. [12] However, our findings revealed that there was no significant difference in the knowledge of our physicians according to their history of training. That their previous training was not reflected in the scores of the participants might in fact, be due to the small sample size or inaccuracy of reporting. It may also be due to the poor quality and/or amount of the training material. In general, undergraduate education and training on palliative care will be inadequate for the future practice of physicians unless it is supplemented with regular postgraduate continuous medical education.

Moreover, it was expected that the residents who are working in internal medicine, emergency, and surgery would have significantly better knowledge than their colleagues in other departments (e.g., dermatology, ophthalmology, etc.). This is based on the assumption that patients in the terminal state of illness and in need of palliative care are usually seen in one of these three specialties. However, our study revealed that the scores of the residents in these departments were not significantly better.


   Conclusion Top


Resident physicians enrolled in postgraduate programs have less than adequate knowledge of basic palliative care. Substantial efforts should be made to incorporate a module on palliative care in theoretical and practical training of medical students and resident physicians.


   Acknowledgments Top


I am heartily thankful to my supervisor, Dr. Mahdi Qadi for his encouragement and guidance. I also offer my regards and blessings to my advisor Dr. Muhammad Alshahri for his golden advice and valuable comments.

 
   References Top

1.Canadian Hospice and Palliative Care Association.History of Palliative Care. Available from: http://www.chpca.net/History. [Last accessed on 2010 Mar 7].  Back to cited text no. 1
    
2.WHO. WHO definition of palliative care. Available from: http://www.who.int/cancer/palliative/definition/en/. [Last accessed on 2010 Mar 7].  Back to cited text no. 2
    
3.Boog KM, Tester CY, Chochinov HM. Palliative care: a practical guide for the health professional: Finding meaning and purpose in life and death. United States: Elsevier Health Sciences; 2007.   Back to cited text no. 3
    
4.Catalonia MO. Barcelona declaration. MOH Catalonia, Spain; 1995.  Back to cited text no. 4
    
5.Al-Shahri MZ, Brown S, Bruera E. Proposal for national program in Saudi Arabia palliative care. Saudi Med J 2004;25:1791-5.  Back to cited text no. 5
    
6.Al Shahri MZ, Brown S, Ezzat A, Khatib O. Palliative care initiative for the Eastern Mediterranean region. Ann Saudi Med 2004;24:465-8.  Back to cited text no. 6
    
7.Burge F, McIntyre P, Kaufman D, Cummings I, Frager G, Pollett A. Family medicine residents′ knowledge and attitudes about end-of-life care. J Palliat Care 2006;16:5-12.  Back to cited text no. 7
    
8.Stjernswärd J, Colleau SM, Ventafridda V. The World Health Organization Cancer Pain and Palliative Care Program. Past, present and future. J Pain Symptom Manage 1996;12:65-72.  Back to cited text no. 8
    
9.Stein GL. Providing palliative care to people with intellectual disabilities: services, staff knowledge, and challenges. J Palliat Med 2008;11:1241-8.  Back to cited text no. 9
    
10.Wiese CH, Loffler EK, Vormelker J, Meyer N, Taghavi M, Strumpf M, et al. Cancer pain therapy in palliative care patients: knowledge of prehospital emergency physicians in training: Prospective questionnaire-based investigation. Schmerz 2010;24:508-16.  Back to cited text no. 10
    
11.Dwyer L. Palliative medicine in India. Palliat Med 1997;11:487-8.  Back to cited text no. 11
    
12.Papke J, Freier W. Knowledge and experience of palliative medicine among general practitioners in Germany. Dtsch Med Wochenschr 2007;132:2620-3.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2]


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