Palliative Care education in Armenia: perspectives of first-year Armenian physician residents

Abstract

Background Due to developing demographic changes, including an aging society and the increasing prevalence of non-communicable diseases, Palliative Care is increasingly highlighted as a universal healthcare need. The need for Palliative Care in Armenia is set against the context of an underdeveloped healthcare system. Further, the absence of palliative medicine within medical education, particularly undergraduate education in Armenia presents a major barrier to improving care. This research aimed to assess the perception of young Armenian physicians’ understanding of Palliative Care, its perceived status in Armenia and the experience and influence of any engaged Palliative Care education. Methods Twenty Armenian first-year residents with different specializations were interviewed July and September 2016 regarding: understanding/knowledge, experiences, perceived competence, and expectations of Palliative Care and Palliative Care education. The transcripts from these semi-structured interviews were analyzed using Qualitative Content Analysis. Results Participants perceived that Armenia’s health care system lacked sufficient Palliative Care and Palliative Care education. Although elements of Palliative Care were included in different specialty teaching, this provided just a partial understanding of typical Palliative Care patients/symptoms, approaches to holistic care, and crucially key communication skills. Challenges noted by participants in caring for Palliative Care patients included emotional difficulties, communication of diagnosis/prognosis, uninformed patients and concerns for patients, families, and physicians. Self-confidence in caring for patients with incurable illness varied. Participants hoped for increasing availability and accessibility of Palliative Care, and extension of clinical education in Palliative Care at all levels (undergraduate, postgraduate, specialization). Conclusions Absence of training has resulted in misconceptions and ignorance of common concepts and practices in Palliative Care. Palliative Care education needs to be systematically developed and integrated into clinical training within Armenia. This research may provide a rallying call for changes within the core curricula in Armenia and may also encourage collaborative development in associated countries of the Caucasus region.

Perspectives, perceived self-efficacy, and preparedness of newly qualified physicians’ in practising palliative care—a qualitative study

“…All of these issues were mirrored in our data. Furthermore, the issues raised by interviewees regarding their perceived competence in practising PC are comparable to perspectives and perceptions of first-year Armenian physicians reported in a recent survey [ 42 ], where insufficient PC education was outlined as a contributing factor. The perceived positive impact of training and experience in PC was also emphasised by interviewees in our study.…”

“…So, it becomes a little bit more difficult. " -P5E, 42 On the flipside, a positive connection between perceived self-efficacy and preparedness in breaking bad news and respondents' PC knowledge and clinical experience, was repeatedly emphasised.…”

“…So I, when I talk to the relatives, I'm more confident. " -P5I, 42 The discussion on the limitations of family involvement included the workload and time restrictions of NQPs. Additionally, the economic constraints of a resourcepoor setting associated with a lack of awareness and sensitisation to PC benefits among many patients and relatives was stated as one of the challenges of involving the family.…”