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Evaluating the amount of knowledge about palliative care concepts among health professionals and medical students in the Gaza Strip : a cross-sectional study
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Background: Improvements in diagnostic facilities and health-care services result in increased numbers of patients with end-stage disease being diagnosed and improvements in medical care for these patients resulting in longer life expectancy. This result generates the need to develop an integrative care system covering patient's physical, psychological, social, and spiritual needs. In the Gaza Strip, the scarcity of palliative care professionals reveals the necessity to develop such care systems. This study evaluated the knowledge of physicians, nurses, and medical students in the Gaza Strip hospitals about palliative care concepts.
Methods: A cross-sectional study was conducted in five hospitals in the Gaza Strip, occupied Palestinian territory. Eligible to participate were all physicians, nurses, and medical students who were willing to participate. In total, 352 participants completed the self-administered, validated Palliative Care Knowledge Test. The primary outcome was participant's amount of knowledge on palliative care concepts (including 20 questions on five subscales). The sample size was chosen on the basis of the Epi-Info tool (with a confidence level of 0·95). Results were analysed using SPSS version 23, a one-way ANOVA, and post-hoc tests. Ethical approval was obtained from the Palestinian Health Research Council Helsinki Committee and consent was obtained from the participants.
Findings: Patients were recruited from Sept 1 to Dec 31, 2019. The mean age of the 352 participants was 31·9 years (SD 9·5). 210 (59·7%) participants were male, 142 (40·3%) were female, 97 (27·6%) were physicians, 162 (46·0%) were nurses, and 93 (26·4%) were students. The overall average total correct score (of which 100% indicated all questions were answered correctly and reflected the maximum level of knowledge) of the subscales was 47·0%. The average scores across all participants were: 68·9% for philosophy, 41·3% for pain, 37·2% for dyspnoea, 48·5% for psychiatric problems, and 39·2% for gastrointestinal problems. Men scored higher than women, but the difference was not significant (p>0·05). There was a statistically significant difference between physicians, nurses, and students in two subscales (philosophy and dyspnoea) as established by a one-way ANOVA (F=7·17, p=0·001 for philosophy; F=4·67, p=0·010 for dyspnoea). A Bonferroni post-hoc test revealed that physicians' knowledge in philosophy was significantly higher than that of nurses, with a mean difference in questionnaire scores of 25·2%; but notably, the students' knowledge was significantly higher than that of nurses, with a mean difference of 32·6%. Additionally, physicians' knowledge in dyspnoea was significantly higher than nurses' by a mean difference of 0·386 and higher than students' by a mean difference of 22·7%. Other subscales did not show any significant differences. Significant differences were found in the subscale scores between different hospitals, except for gastrointestinal problems.
Interpretation: The overall low Palliative Care Knowledge Test scores indicate large knowledge gaps. Although philosophy and psychiatric problems were better understood than other concepts, the results were still substantially less than the ideal percentage of 100%. Poor knowledge is likely to reflect poor practice and care for patients with end-stage disease. Students undergo intensive palliative care training at one university, as reflected in their significantly better scores for some subscales, suggesting the effectiveness of educational measures. Palliative care integration is a joint responsibility of professionals and decision makers and should be strengthened by building palliative care teams as well as staff education across all hospitals.
http://dx.doi.org/10.1016/S0140-6736(22)01169-2
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