<p>Perception of palliative medicine by health care professionals at a teaching community hospital: what is the key to a “palliative attitude”?</p>

Abstract

Background: With growing expense in chronic illness and end-of-life (EOL) care, population-based interventions are needed to reduce the health care cost and improve patients’ quality of life. The authors believe that promotion of palliative medicine is one such intervention and this promotion depends on the acceptance of palliative medicine concepts by health care professionals. Aims of the studies: Perception of palliative medicine in chronic illness and in EOL care by health care professionals was learned in two studies carried out at a teaching community hospital 14 years apart. Participants and methods: Voluntary and anonymous surveys were randomly distributed among physicians, nurses, and social workers/case managers. Participants in the two studies presented two different groups of health care providers. Results of the studies: Results of the two studies were essentially similar. On most of the issues, respondents’ perceptions were consistent with palliative medicine concepts and confidence in palliation grew over the 14-year period. The authors call this approach a “palliative attitude.” Physicians with greater experience performed better in care planning. Younger physicians were more perceptive to withdrawal of care in futile cases. Participants’ religion had no influence on perception of palliative medicine. Attendance of educational activities did not influence attitudes of health care professionals. Health care providers who favored involvement of palliative care teams in patients’ management were better in care planning, interpretation of the DNR consent, use of opioids at the EOL, use of intensive care, and evaluation of the disease trajectory. Conclusion: The authors conclude that direct interaction between palliative and interdisciplinary teams in clinical practice is the key factor in the education of health care professionals, in the development of a “palliative attitude,” and in the promotion of palliative medicine.

Barriers to recruitment into emergency department-initiated palliative care: a sub-study of a multi-site, randomized controlled trial

“…The reasons for this are undoubtedly multifactorial, but it is possible that this reflects a shift of attitude toward palliative care within the healthcare community. While some research suggests that providers still hold perceptions that palliative care is only appropriate at the end of life, there is a growing body of evidence which demonstrates that physicians have a greater understanding of the role of palliative care and are more confident in referring patients to palliative care services [ 12 , 27 , 28 ]. A recent study analyzing the perceptions of palliative care among healthcare providers before and after implementation of a palliative medicine division found increased attendance in educational activities and increased confidence in palliative care [ 28 ].…”

Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon

“…Regardless, Islamic guidance in the form of Fatwa has accorded medical professionals with the ability to undertake DNR decisions in hopeless medical cases irrespective of family and patient preferences [ 24 ]. This could account for studies reporting that Muslim religiosity does not affect views of the religious feasibility of DNR decisions [ 25 ] and palliative medicine among physicians [ 26 ], which highlights the need to account for the capacity of other factors, such as country of origin and country of practice, to overshadow religious beliefs [ 25 ].…”

Barriers to recruitment into a randomized controlled trial comparing two modes of emergency department-initiated palliative care&nbsp;

“…Additionally, a recent study analyzing the perceptions of palliative care among healthcare providers before and after implementation of a palliative medicine division found increased attendance in educational activities and increased con dence in palliative care. 25 Within the same study, providers who favored co-management with palliative care held core values that aligned with current concepts, such as advanced care planning. 25 We expect that as the number of palliative care programs in hospitals across the country increases, understanding and acceptance of palliative care amongst providers will continue to grow and foster a new set of beliefs and norms.…”

“…25 Within the same study, providers who favored co-management with palliative care held core values that aligned with current concepts, such as advanced care planning. 25 We expect that as the number of palliative care programs in hospitals across the country increases, understanding and acceptance of palliative care amongst providers will continue to grow and foster a new set of beliefs and norms. 26 Our results also demonstrated that family and caregivers did not impede recruitment.…”

“…Recent studies have found physicians have a greater understanding of the role of palliative care and are more con dent in referring patients to palliative care services. 24,25 Physicians were given the opportunity to opt-out their patients in the EMPallA study prior to recruitment, but few took the study team up on the offer. Additionally, a recent study analyzing the perceptions of palliative care among healthcare providers before and after implementation of a palliative medicine division found increased attendance in educational activities and increased con dence in palliative care.…”