Knowledge and Attitudes Toward Hospice and Palliative Care: Instrument Validation Among Emergency Providers

Abstract

Background: Emergency providers can engage in goals of care discussions and hospice and palliative care referrals. Little is known about their knowledge and attitudes, which may influence these care practices. Objective: This study aims to re-validate the knowledge and attitude towards hospice and palliative care (KAHP) scale and assess the scale’s latent constructs among emergency providers. Methods: The scale consists of ten items measured on a five-point Likert scale. Five of the ten items were reverse scored. Content validation was performed by ten experts in Hospice and Palliative Medicine and Emergency Medicine. Baseline surveys of emergency physicians, advance practice providers, and nurses conducted in the context of a pragmatic, randomized control trial were used for the item analysis and the exploratory and confirmatory factor analyses. Results: The KAHP scale is a ten-item scale scored from 10 to 50. Based on the synthesis of content validation results and the item analysis, all ten items were retained. The item and scale Content Validity Index were each .91. The reliability of the scale was .64 and the exploratory factor analysis identified three underlying constructs defined as self-rated knowledge, support for hospice and palliative care practice, and views on provider-patient communication. The presence of good model fit indices supported the structural integrity of the constructs. Conclusion: We present a validated instrument that is suitable for assessing knowledge and attitude variations toward interventions designed to improve hospice and palliative care practice among emergency providers.

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

“…Poor knowledge scores were associated with inadequate PC training and limited available guidelines for practice. 17 , 18 , 19 Interestingly, we found no consistent improvement in knowledge as level of training in emergency care progressed. Scores did not appear to differ between subjects who had received some training versus those who had not, those with a basic medical degree and those with a DipPEC or between registrars and medical officers.…”

“…This may be because ED doctors are experienced in the use of potent analgesics, such as the opioids. 24 As reported in other studies, 17 , 18 however, we noticed weaknesses in knowledge of the management of other physical symptoms and of psychological issues.…”

“…The participant’s length of time since graduating from medical school has shown a significant positive effect on knowledge in some studies. 17 , 18 This may be because of the introduction of compulsory undergraduate coursework in palliative medicine. Poor knowledge scores were associated with inadequate PC training and limited available guidelines for practice.…”

“…Numerous studies have explored knowledge of PC and attitudes towards it among healthcare workers. 6 , 10 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Studies have suggested that specific healthcare education for healthcare providers is lacking in many African countries. 10 This is important given that there is evidence that healthcare providers demonstrate better knowledge of and attitudes towards PC after receiving specific training.…”

Predictors of Intense Treatment in the Emergency Department Among Older Adults With Serious Life-Limiting Illnesses: A Five-Year Cross-sectional Analysis of Medicare Claims Data

“…Considering that the population classified as having serious life-limiting illnesses had an estimated six months or less to live, it is debatable if such ICU admission these older adults experienced were of any benefit. While physician characteristics and local practice patterns may influence the decision to provide intense care to patients with serious life-limiting illnesses, [30][31][32][33][34] patients and family determinants equally exist. Earlier studies have reported that physicians' race/ethnicity, years of practice, and attitudes toward end-of-life care influence the decision to provide life-prolonging treatments for dying patients.…”