Analysis of Physician Views Towards End-of-Life Care

Analysis of Physician Views Towards End-of-Life CareIntroductionIt has been estimated that more(prenominal) than 15 m chargeion people w gouty suffer pubic louse worldwide by 2020(1). According to the report by Ministry of wellness, over 30000 people die because of malignant neoplastic disease annually and slightly 70000 new cases occur every year(2). Therefore crabby person is the third just al to the highest degree common cause of cobblers last in Iran following coronary heart disease and accidents (3, 4). There are considerable evidences that most of patients who encounter a carriage-threatening jibe such as cancer are growing speedily in Iran in the last some decades (1, 5, 6).Unfortunately, most of these patients are diagnosed in the late stages of disease, in that respectfore they reach a stage that surgery, chem differentapy and other curative interventions are unable to improve their woodland of animation. They often suffer severe distress, in physical, psychol ogical, spiritual, social and financial dimensions (7)Hence, the easement from such a suffering is considered as a basic and ecumenical human right (8) and a basic action in achieving planetary Health Coverage(UHC) which has been introduced by World Health Organization in late(a) years (9). Universal health coverage is defined as entranceway to key promotive, preventive, curative , rehabilitative, and palliative get by for all at an low-cost cost(8).Palliative or hospice heraldic bearing is an interdisciplinary, comprehensive, patient-centered approach in response to these needs. In other word hospice is a model for expiry-of- action care based on a team approach to control symptoms, manage pain, and provide worked up and spiritual support for terminally ill patients and their families (10). According to the World Health Organization (WHO), palliative care is an approach to improve the quality of spiritedness of for threatening illness situations (11). The hospice care is no t to cure disease scarce alleviate symptoms and improve quality of animation at the oddment of life history are the main objectives. furthermore the mission of hospice care is to enable the end of life patients to die at mob, with their beloved people around them (12). in spite of the fact that cancer is a leading cause of mortality with rapidly growing rate and late stage diagnoses in Iran, very minor is known about the physicians judgments, attitudes and experiences about of end-of-life care. This survey surveyed Persian physicians attitudes and practices on end-of-life care for the first time.Materials MethodsA cross-sectional study was conducted among all doctors who participated in the biggest regional annually conducted gentilityal seminar in the Tabriz city and end of year medical checkup checkup students in September 2012. This Physicians came from East-Azerbaijan and some provinces in north-east of Iran. Generally seminar is conducted annually and consists of clinician-specialists in different specialty groups. The seminar presented the opportunity to obtain current nurture on End of life care training, knowledge and attitudes, demographic and organisational characteristics, and personal experience with end of life patients.The population consisted of 560 medical students, world(a) physicians, specialist and sub-specialists. The sample size was determined based on the WHO tribute on 400 sample and results of a pilot study consisting of 30 physicians which resulted in an Odds Ratio of 1.8. Considering 95% confidence and 95% power, twain tailed trial run, and utilizing G-Power software, 161 cases were computed and regarding a dropout rate of 45% the total sample size increased to at least 234 cases.Data were collected using a voluntary self-administered, anonymous questionnaire that originally developed by John Mastrojohn and Agnes Csikos in 2010 (13) and we confirmed and retained its harshness and reli cleverness after definitio n to Farsi in this survey. A translation back translation process was used to iterate the measure devil face language specialists and two native English speaking persons respectively involved in the translation and back translation processes. In addition to apply the translated questionnaire in the study population on 15 persons, a linguistic edit of the measure was done. The content harshness of the questionnaire was evaluated based on opinions of an expert panel consisted of eight specialists in the palm of Health service research. After conducting some modifications and corrections the content validity was approved. In addition, we assessed the reliability of questionnaire totally using Cronbachs Alpha coefficient. The Cronbachs Alpha values were calculated for all 22 items (0.92.) and showed reasonable reliability (internal consistency).Questionnaires were distributed prior to the sessions and internship workshops. A total of 38.3% (215 of 560) of participants completed th e survey. Participation was voluntary and no incentives were offered. Completion of the anonymous questionnaire was taken as consent to participate in the study. Questionnaire includes a letter explaining its general purpose and providing assurances of the confidentiality of individual answers. Questionnaire contains 22 questions about care of terminally ill patients, 2 questions about personal (age and sex) and 5 questions in relation to organizational characteristics.All returned questionnaires were checked manually for completeness onwards they were forwarded to electronic data computer. Frequencies and percentages were calculated to compare results and Cross-tabulations using Kendalls tau-b to test for significance were conducted to compare within-sample bivariate associations between demographic and practice variables with belief and attitudinal variables. Most of these tests were not statistically world-shattering, with the exception of those reported here. All study data we re analyzed using SPSS version 16.0.Only quantitative results are discussed in this article.Ethical consideration for this study and the study protocol were approved by the Ethics Committee of Tabriz University of Medical Sciences (TUMS), which was in compliance with Helsinki Declaration.ResultsIn this study, 215 questionnaires were completed from 560 (overall response rate of 38.3%). Of all participants, 60% were males. In wrong of their graduated universities, (76.2%) of the respondents were graduated students of Tabriz medical university. Every physician had visited 24.63 (16.57) patients every daytime and the average length of service was 5.23 (4.53) years. The physicians identified their degrees as 60.7% generalist and 39.3% specialist.Socio-demographic and organizational characteristics of participations are shown in table 1.According to the table 1 more than eighty percent of physicians have had at last 1-3 EOL patients. It is considerable that 72% of mentioned patients rec eived medical care in the hospital, 23% at home and 4.7% in other settings.Further investigation did not show both statically momentous differences between gender groups, specialty or generalists in the piece of their daily visiting patients, however differences about their terminal illness patients were statically meaty (pPhysicians believes about the most appropriate theatrical role of care for end of life patients illustrated in Table2The responses of physicians about opinion on current cares for end of life patients in our country were as following 1.9 percent bespeakd the best, 15.8 percent equal with deficiencies, 59.5 percent insufficient, and finally 22.8 percent there is not any care. In other words nearly all of the physicians evaluated these services as insufficient. Furthermore their response to In your opinion, the best setting for care of terminally ill patients is usually approximately were20 percent hospital, 62 percent the patients home, 18 percent a nursing home, that obviously is in line of descent with their practices that indicate more than 72.4 percent of end of life patients were cared in hospital. Furthermore the differences among two groups of physicians about Best Setting for care of terminally ill patients were statically significant (pPhysicians beliefs about the ability of end of life patients to maintain dignity until death showed in the Table 3Further investigation about mentioned differences in last table didnt show any significant kind among specialty, age, gender, work drift and graduating groups of physicians.Nearly one percent of physicians stated that they were quite an knowledgeable about hospice care and 57.1 percent did not posses any familiarity with this type of care. In other way, 97.2 percent of physicians indicated that they would not participate in educational course about hospice care. Hence 82.2 percent of them were interested in active in educational course on hospice care. Table 4 shows familiarity of physicians with hospice care and their interest in act in educational course.Table 4 physicians familiarity, behavioral with hospice care and educational courseInvestigation on significant relationship between physicians knowledge about hospice and demographic characteristics were meaningful barely in Age groups, where differences in physicians on searching workshop in different groups were significant only if in work place (p=0.025). railleryThere are numbers of important implications of this study. First, the study demonstrates that familiarity of Iranian physicians with end of life cares was low in spite of frequent contact with those patients. Second, there isnt any kind of structured or organized body to sky services for end of life patients. Third, there isnt any developed educational plan neither in medical school curriculums nor continuity medical education programs.In this study the participation rate was 38.3% which was lower than that of uniform studies in Hungar y (54%) , United States (48%) and Pakistan (63.6%)(13, 14). This differences could be attributed to methods of sampling and low take of Iranian physicians knowledge about end of life cares .Most of the Iranian physicians (72%) in the current study claim that they didnt have any knowledge about hospice care, which is similar to Pakistani doctors (57.1%) who stated that they had heard about a hospice (14). In contrast to the most of U.S. physicians who were quite knowledgeable most of the Hungarian physicians had only a basic knowledge (13). However there is a proud train of interest in the physicians of U.S., Hungary, Iran (82%), and Pakistan to participate in continuing medical education to learn more about hospice care. These findings are consistent with prior studies that indicate physicians common interest in continuing medical education for end-of-life care(7, 13-17).In this study 72% of EOL patients received medical care in the hospital and 23% at home, whereas other studie s are focusing to physicians sense of patients preferred place for dyeing(18, 19).However 27% of Iranian physicians mentioned that the preferred place of providing terminal care is hospital, the reasons for this obvious conflict are related to wishing of delivering any end of life care in health system in hospital or home. Furthermore 82% of physicians demonstrated that level of present end of life care in Iran is insufficient and 22% believed that there is not any structured service for end of life patients. This finding is in accordance with other study results and reports, thereforeIran was categorized in second group on Palliative Care Development in the world (20). Iranian physicians believed that combination of curative and palliative care is most appropriate approach for terminally ill patients (61.7%) which matches with U.S. physicians and contrasts with most of Hungarian physicians that support a palliative care only approach for terminally ill patients (13). This may be attributed to the current practice of aggressive curative sermon until the last days of life in Iran and Hungary.Iranian Physicians beliefs about the ability of End of life patient to maintain personal dignity were differed from those of other countries(13, 19) especially for this opinion Most or all end of life patients are not able to maintain personal dignity it was 18% in our study but in the mentioned countries it was 9% and 5 %. These differences could be attributed to difference of social contexts and family structures in these three countries.Most of the Iranian physicians in the current study claim that they would not participate in educational course about hospice care neither would they do in collage curriculums nor in continuity medical education programs. These results are in contrast to most of the U.S. and Hungarian physicians (13) but are in accordance with introductory studies on Iranian nurses (8). Intense interest of Iranian physicians to participate in continui ng medical education for end-of-life care is clear evidence for this finding.ConclusionsA growing trend of chronic, non-communicable diseases especially cancers in Iran, has led to new condition of needs for providing care to EOL patients. Furthermore our findings clearly indicate unacceptable level of knowledge and attitudes of physicians about delivering services for EOL patients. Physicians of our study were interested in participating in continuing education programs about EOL patient. In response to these realities, design the specific care for EOL patients, is inevitable and should be starting as in short as possible.Furthermore the education of physicians about EOL care should be include in the formal curriculums of medical schools and continuous medical education programs.