Vaishali Sisodia

Study of nurses' knowledge about palliative care: A quantitative cross-sectional survey

Context: Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care. Aims: The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge test (PCKT). Settings and Design: Cross-sectional survey of 363 nurses in a multispecialty hospital. Materials and Methods: The study utilized a self-report questionnaire- PCKT developed by Nakazawa et al., which had 20 items (statements about palliative care) for each of which the person had to indicate ‘correct’, ‘incorrect’, or ‘unsure.’ The PCKT had 5 subscales (philosophy- 2 items, pain- 6 items, dyspnea- 4 items, psychiatric problems- 4 items, and gastro-intestinal problems- 4 items). Statistical Analysis Used: Comparison across individual and professional variables for both dimensions were done using one-way ANOVA, and correlations were done using Karl-Pearsons co-efficient using SPSS version 16.0 for Windows. Results: The overall total score of PCKT was 7.16 ± 2.69 (35.8%). The philosophy score was 73 ± .65 (36.5%), pain score was 2.09 ± 1.19 (34.83%), dyspnea score was 1.13 ± .95 (28.25%), psychiatric problems score was 1.83 ± 1.02 (45.75%), and gastro-intestinal problems score was 1.36 ± .97 (34%). (P = .00). The female nurses scored higher than their male counterparts, but the difference was not significant (P > .05). Conclusions: Overall level of knowledge about palliative care was poor, and nurses had a greater knowledge about psychiatric problems and philosophy than the other aspects indicated in PCKT.

Effects of palliative care training program on knowledge, attitudes, beliefs and experiences among student physiotherapists: A preliminary quasi-experimental study

Background: Physiotherapists play an inherent role in the multidisciplinary palliative care team. Existing knowledge, attitudes, beliefs and experiences influence their team participation in palliative care. Aims: The objective of this study was to assess the changes in knowledge, attitudes, beliefs and experiences among student physiotherapists who attended a palliative care training program. Settings and Design: Preliminary quasi-experimental study design, conducted at an academic institution. Materials and Methods: Fifty-two student physiotherapists of either gender (12 male, 40 female) of age (20.51±1.78 years) who attended a palliative care training program which comprised lectures and case examples of six-hours duration participated in this study. The study was performed after getting institutional approval and obtaining participants’ written informed consent. The lecture content comprised WHO definition of palliative care, spiritual aspects of life, death and healing, principles, levels and models of palliative care, and role of physiotherapists in a palliative care team. The physical therapy in palliative care-knowledge, attitudes, beliefs and experiences scale (PTiPC-KABE Scale)- modified from palliative care attitudes scale were used for assessing the participants before and after the program. Statistical Analysis: Paired t-test and Wilcoxon signed rank test at 95% confidence interval using SPSS 11.5 for Windows. Results: Statistically significant differences (P<0.05) were noted for all four subscales- knowledge (7.84±4.61 points), attitudes (9.46±8.06 points), beliefs (4.88±3.29 points) and experiences (15.8±11.28 points) out of a total score of 104 points. Conclusions: The focus-group training program produced a significant positive change about palliative care in knowledge, attitudes, beliefs and experiences among student physiotherapists.

Mechanism-based classification and physical therapy management of persons with cancer pain: A prospective case series

Context: Mechanism-based classification (MBC) was established with current evidence and physical therapy (PT) management methods for both cancer and for noncancer pain. Aims: This study aims to describe the efficacy of MBC-based PT in persons with primary complaints of cancer pain. Settings and Design: A prospective case series of patients who attended the physiotherapy department of a multispecialty university-affiliated teaching hospital. Material and Methods: A total of 24 adults (18 female, 6 male) aged 47.5 ± 10.6 years, with primary diagnosis of heterogeneous group of cancer, chief complaints of chronic disabling pain were included in the study on their consent for participation The patients were evaluated and classified on the basis of five predominant mechanisms for pain. Physical therapy interventions were recommended based on mechanisms identified and home program was prescribed with a patient log to ensure compliance. Treatments were given in five consecutive weekly sessions for five weeks each of 30 min duration. Statistical Analysis Used: Pre–post comparisons for pain severity (PS) and pain interference (PI) subscales of Brief pain inventory-Cancer pain (BPI-CP) and, European organization for research and treatment in cancer-quality of life questionnaire (EORTC-QLQ-C30) were done using Wilcoxon signed-rank test at 95% confidence interval using SPSS for Windows version 16.0 (SPSS Inc, Chicago, IL). Results: There were statistically significant (P < 0.05) reduction in pain severity, pain interference and total BPI-CP scores, and the EORTC-QLQ-C30. Conclusion: MBC-PT was effective for improving BPI-CP and EORTC-QLQ-C30 scores in people with cancer pain.

Levels of Professionalism among Physical Therapists in India- A National Cross-Sectional Survey

Background and purpose: The American Physical Therapy Association (APTA) developed the core values of leadership, administration, management and professionalism for physical therapists. The aim of this study was to assess the levels of professionalism among physical therapists in India. Materials and methods: This cross-sectional study was done using a survey questionnaire- Professionalism In Physical Therapy- Core Values (PPTCV) instrument that consisted of sample indicators for each of the seven core values- accountability (10 indicators), altruism (5 indicators), compassion/caring (11 indicators), excellence (11 indicators), integrity (12 indicators), professional duty (7 indicators), and social responsibility (12 indicators). Each sample indicator was to be rated using a 5-point Likert scale from ‘never, rarely, occasionally, frequently and rarely.’ 771 eligible questionnaires out of 889 participants with a response rate of 91.33% were analyzed and computed based upon individual- and profession-related variables. Descriptive analysis was done using SPSS version 11.5 (SPSS Inc, IL) at 95% confidence interval. Results: Overall, high levels of professionalism was reported by post-graduate students, followed by researchers and teaching faculty. Younger male physical therapy students were more likely to report high levels of professionalism. Individually, accountability was high among teaching faculty, altruism, compassion/caring and social responsibility among clinician-therapists, and integrity and professional duty was high among researchers. No single professional category showed high levels of professionalism in all seven core values. Conclusion: Overall levels of professionalism among Indian physical therapists were moderate, and altruism and compassion levels were also low. Other indicators of professionalism were fairly evenly distributed among the students and therapists, and between genders. The study findings are of importance to develop curricular and educational modifications to improve levels of professionalism among physical therapists in India and future studies are warranted around the world.

Reporting of "death and bereavement care": A systematic review and quantitative analysis of research publications in palliative care journals

Context: The most common concern among terminally ill patients in palliative care is death, which is often perceived as a psychosocial stigma. The knowledge, attitudes, beliefs, and experiences regarding death influence both the delivery of palliative care and its outcomes. Aims: This study was conducted with an aim to perform a quantitative analysis of research publications in palliative care journals for articles on death and bereavement care (DBC). Settings and Design: Systematic review of palliative care journals. Materials and Methods: Twelve palliative care journals were searched for articles related to death in the title of the articles published in 2009 and 2010. The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles category was further classified according to study designs. Statistical Analysis: Descriptive analysis using frequencies and percentiles was done using SPSS for Windows version 11.5. Results: The overall reporting rate among all journals was 5.27% (96/1821), and Palliat Support Care had the highest reporting rate of 14.4% (17/118), followed by BMC Palliat Care with 9.3% (4/43) and Palliat Med with 7.4% (16/216). Conclusions: The overall reporting rate for DBC articles in palliative care journals was very low, and very few randomized clinical trials and systematic reviews were found. The study findings indicate a lack of adequate evidence base for DBC.

An exploratory analysis of levels of evidence for articles published in Indian journal of palliative care in the years 2010-2011

Context: Indian Journal of Palliative Care (IJPC) provides a comprehensive multidisciplinary evidence base for an evidence-informed clinical decision making. Aims: To analyze the levels of evidence of articles published in IJPC in the years 2010-2011. Settings and Design: Systematic review of palliative care journals. Materials and Methods: Systematic review of articles was done and was scored according to Center for Evidence-Based Medicine levels of evidence into any of the five grades. The articles were categorized based upon article type, number of authors, study approach, age focus, population focus, disease focus, goals of care, domains of care, models of care, and year of publication. Statistical Analysis Used: All descriptive analysis was done using frequencies and percentiles, and association between all categorical variables was done using Chi-square test at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) version 16 for Windows (SPSS Inc, Chicago, IL). Results: There was a greater prevalence of low level evidence (level 4: n = 46, 51%; level 5: n = 35, 39%) among the 90 selected articles, and article type (original articles with higher level of evidence, P = 0.000), article approach (analytical studies with higher level of evidence, P = 0.000), domains of palliative care (practice-related studies with higher level of evidence, P = 0.000) and models of care (biological or psychosocial model with higher level of evidence, P = 0.044) had a significant association with the grade of levels of evidence. Association with other factors was not statistically significant (P < 0.05). Conclusions: The levels of research evidence for palliative care provided by articles published in IJPC were predominantly level 4 and level 5, and there is scope for more high quality evidence to inform palliative care decisions in the developing countries.