|Year : 2014 | Volume
| Issue : 4 | Page : 250-253
Knowledge regarding palliative care amongst medical and dental postgraduate students of medical university in western Maharashtra, India
Purushottam A Giri, Deepak B Phalke
Department of Community Medicine (PSM), Rural Medical College and Pravara Rural Hospital, Loni, Maharashtra, India
|Date of Web Publication||16-Oct-2014|
Purushottam A Giri
Department of Community Medicine (PSM), Rural Medical College of Pravara Institute of Medical Sciences (Deemed University), Loni - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Palliative care is a relatively new field of medicine. The goal of palliative care is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains. However, there is a paucity of studies on knowledge among postgraduate students from medical and dental disciplines. Objectives: The present study was conducted to assess the knowledge about palliative care amongst postgraduate students of Medical University in Western Maharashtra. Materials and Methods: A cross-sectional study was conducted amongst a total of 178 postgraduate students which includes 112 medical and 66 dental disciplines of Medical University in Western Maharashtra during the period of June-August 2013. Data was analyzed in the form of percentage and proportions and Chi-square test was applied whenever necessary. Results: In the present study, 42.1% students didn't know the concept of 'autonomy' in palliative care, while 107 (60.1%) of students believed that most preferable route of administration in palliative care for treating chronic cases is oral. Among medical students 41.6% had shown overall good level of knowledge, while only 16.6% of dental students showed overall good level of knowledge. There was a significant difference found in the level of knowledge among the postgraduates between two disciplines. Conclusion: The study revealed the inadequacy in knowledge amongst postgraduate students of both disciplines; however knowledge level of dental was poor as compared to medical students. There is need to introduce palliative care in postgraduate curriculum of all health professional education.
Keywords: Knowledge, medical university, palliative care, postgraduate students
|How to cite this article:|
Giri PA, Phalke DB. Knowledge regarding palliative care amongst medical and dental postgraduate students of medical university in western Maharashtra, India. CHRISMED J Health Res 2014;1:250-3
|How to cite this URL:|
Giri PA, Phalke DB. Knowledge regarding palliative care amongst medical and dental postgraduate students of medical university in western Maharashtra, India. CHRISMED J Health Res [serial online] 2014 [cited 2017 May 25];1:250-3. Available from: http://www.cjhr.org/text.asp?2014/1/4/250/142989
| Introduction|| |
Palliative care is not about whether to treat or not to treat, but about what is the best treatment. The name comes from the term 'palliate,' which means, to make less severe or intense. In medicine, 'palliate' means to lessen the severity of pain or disease without curing or removing the underlying cause. Palliative care is proactive care which seeks to maximize quality of life for people and families facing life threatening illnesses.  World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the 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".  In India, palliative care training is almost nonexistent in most of health care training program curriculum. It was not a mandatory part of the undergraduate or postgraduate curriculum, and it remained the responsibility of the medical colleges to offer courses in palliative care.  Studies have shown that doctors and other health care professionals lack knowledge and confidence in their ability to care for the dying patients, are not rewarded for exhibiting concern over psychosocial issues in end-of-life care, and are unwilling to administer adequate dosages of analgesics or sedatives to dying patients or to withhold or withdraw life support.  Hence the present study was conducted to assess the knowledge regarding various aspects of palliative care amongst medical and dental postgraduate students of Medical University in Western Maharashtra, India.
| Materials and Methods|| |
A cross-sectional study was conducted amongst a total of 178 postgraduate students which includes 112 medical and 66 dental disciplines of Medical University in Western Maharashtra, India during the period of June-August 2013. It is one of the premiere teaching and training Private institution of Western Maharashtra that provides specialist's tertiary care services to patients largely belonging to lower/middle socio-economic strata of the society with rural background. The study population was selected by convenience sampling method. A pre-designed, pre-tested, and self administered questionnaire in English was used based on the previous literature.  The questionnaire consists of questions regarding knowledge on basic concepts of palliative care, management of pain and other symptoms in palliative care, which were in the form of multiple choice questions. Interviews were conducted in respective postgraduate departments by the investigators. All the participants responded positively and cooperated well.
Knowledge on palliative care was assessed through 12 questions. Each correct answer was given one score and the range of the score varied between 0 (with no correct answer) to 12 (for all correct answers). A scoring mechanism was used to understand overall knowledge level. Based on total score, knowledge level on palliative care was categorized into poor (≤4 points), average (5-8 points) and good (≥9 points). The participation to study was on voluntary basis. All participants were given a briefing about objective of the study and assured confidentiality in collection of personal data. Institutional ethical committee approval was obtained for the study. Data was entered in MS Excel and analyzed by using Statistical Package of Social Sciences (SPSS) version-13.0. Statistical significance was set at P ≤ 0.05.
| Results|| |
The response was gathered from a total of 178 participants in the study. The study sample consisted of 126 (70.7%) males and 52 (29.3%) females. The mean age of male postgraduates was 26.2 years (SD = 0.2 years) and the mean age of female was 25.2 years (SD = 1.0 year).
The level of knowledge of the study population is shown in [Table 1]. Among medical students 41.6% had shown good level of knowledge, while only 16.6% of dental students showed good level of knowledge. It was observed that 75.0% of dental students have poor knowledge as compared to 25.0% medical students. Only 61 (34.2%) of the participants knew about correct dose of morphine in palliative care. The commonest cause of diarrhea in palliative care is imbalance of laxative therapy was correctly stated by 104 (58.4%) students. About 93 (52.2%) students considered that pethidine should not be used in palliative care and 107 (60.1%) told the correct route of administration in palliative care for treating chronic cases. The knowledge of postgraduate students pertaining to 'euthanasia' was answered correctly by 106 (59.5%) students. About 104 (58.4%) respondents correctly mentioned that radiotherapist is not a member of palliative care team. More than half (54.5%) respondents could tell the WHO step analgesic ladder correctly. A statistically significant difference was observed in the level of knowledge among the students from medical and dental disciplines.
|Table 1: Assessment of knowledge regarding palliative care in the study population|
Click here to view
| Discussion|| |
The WHO claims that palliative care has to be compulsory in courses leading to a basic health professional qualification. 
The present study revealed the overall inadequacy in knowledge among postgraduate students of both disciplines. Similarly a study by Sandhu et al. mentioned clear gaps in palliative care knowledge among undergraduate health care students. A study by Karkada et al. showed that 79.5% of nursing students had poor knowledge on palliative care. Another study by Prem et al. found that overall level of knowledge about palliative care was poor amongst nurses. One more study by Weber et al. in Germany also found insufficient knowledge about palliative care among final year medical students. A study by Fadare et al. clearly showed the gaps in the knowledge of health care workers in the area of palliative care. Another interventional study by Valsangkar et al. among interns revealed that there is significant increase in level of knowledge regarding palliative care after training workshop.
In present study, 129 (72.4%) postgraduate students correctly mentioned that HIV/AIDS is not a palliative care emergency, which was also found by Bogam et al. in study among undergraduate medical students.
In our study, 41.6% of postgraduate students thought radiotherapist is seldom part of multidisciplinary palliative care team. Similarly studies by Bogam et al. and Sandhu et al. showed that 80.7% and 88.7% undergraduate medical students respectively thought that radiotherapist is a part of multidisciplinary team of palliative care.
More than half of the postgraduate students, that is 97 (54.5%) knew about WHO three step analgesic ladder pattern in our study. High level of knowledge i.e. 90.8% regarding this fact was observed in Bogam et al. study.
In our study, 91 (51.1%) postgraduate students felt that palliative care is useful in end stage heart failure. Similarly studies by Sandhu et al. and Fadare et al. also found that 56.4% and 72.6% of undergraduate students respectively felt that palliative care is useful in end stage heart failure.
In the present study, 'autonomy' refers to patient's right to ask for whatever treatment they choose was correctly stated by 103 (57.8%) postgraduate students. Similarly a study by Bogam et al. found that only 23.8% of the undergraduate medical students knew about the same.
In evaluation study by Pohl G et al. found that the implementation of compulsory palliative care education at the Medical University of Vienna resulted in a significant increase of theoretical knowledge about palliative care aspects in medical students. Though palliative care has been somewhat established in many developed countries of the world, it is an emerging medical specialty in many developing ones with establishment of palliative care centers in India.
Study was based on the convenience sampling method, including only 178 postgraduates, thus the postgraduates who completed the survey may not reflect the knowledge regarding palliative care of all postgraduate disciplines. We also could not study practical application and attitude of postgraduate students pertaining to palliative care.
| Conclusion|| |
Owing to inadequacy in overall knowledge, this study elicits the importance of adopting palliative care in postgraduate students of medical and dental curriculum. There is a need to integrate/introduce palliative care aspects into basic health care training of medical, dental, physiotherapy, and nursing in undergraduate and postgraduate curriculum by respective apex bodies like MCI, DCI, and Nursing Council.
| Acknowledgment|| |
We express our deep sense of gratitude to the Management, Pravara Medical Trust and The Principal, Rural Medical College Loni, Maharashtra, India. We also acknowledge the help of final year (III/II MBBS) medical students of 2010 batch during data collection. We heartily acknowledge the cooperation and support of Dr. Priyadarshini Kulkarni, Medical Director, Cipla Palliative Care Center, Pune for her guidance.
| References|| |
Pohl G, Marosi C, Dieckmann K, Goldner G, Elandt K, Hassler M, et al
. Survey of palliative care concepts among medical students and interns in Austria: A comparison of the old and the new curriculum of the medical university of Vienna. Palliat Care 2008;2:1-7.
Canadian Hospice and Palliative Care Association. History of Palliative Care. Available from: http://www.chpca.net/History
[Last accessed on 2013 May 5].
Samaroo B. Assessing palliative care educational needs of physicians and nurses: Results of a survey. J Palliat Care 1996;12:20-2.
Bogam RR, Kumbhar SM, Sahu SB, Mane AS, Sagare SM, Chowdhury YS. Knowledge of palliative care amongst undergraduate medical students in rural medical college of Maharashtra. Natl J Community Med 2012;3:666-9.
Velayudhan Y, Ollapally M, Upadhyaya V, Nair S, Aldo M. Introduction of palliative care into undergraduate medical and nursing education in India: A critical evaluation. Indian J Palliat Care 2004;10:55-60.
Sandhu S, Salins NS, Kamath A. Palliative care awareness among indian undergraduate health care students: A needs-assessment study to determine incorporation of palliative care education in undergraduate medical, nursing and allied health education. Indian J Palliat Care 2010;16:154-9.
Karkada S, Nayak BS, Malathi. Awareness of palliative care among diploma nursing students. Indian J Palliat Care 2011;17:20-3.
Prem V, Karvannan H, Kumar SP, Karthikbabu S, Syed N, Sisodia V, et al
. Study of nurses′ knowledge about palliative care: A quantitative cross-sectional survey. Indian J Palliat Care 2012;18:122-7.
Weber M, Schmiedel S, Nauck F, Alt-Epping B. Knowledge and attitude of final - year medical students in Germany towards palliative care - an interinstitutional questionnaire-based study. BMC Palliat Care 2011;10:19.
Fadare JO, Obimakinde AM, Afolayan JM, Popoola SO, Aduloju T, Adegun PT. Healthcare workers knowledge and attitude toward palliative care in an emerging tertiary centre in South-West Nigeria. Indian J Palliat Care 2014;20:1-5.
Valsangkar S, Bodhare TN, Pande SB, Bele SD, Rao BS. Evaluation of knowledge among Interns in a medical college regarding palliative care in people living with HIV/AIDS and the impact of a structured intervention. Indian J Palliat Care 2011;17:6-10