Bella S Ehrlich1,2, Narine Movsisyan3, Tsetsegsaikhan Batmunkh4, Ella Kumirova5, Marina V Borisevich6, Kirill Kirgizov7, Dylan E Graetz8, Michael J McNeil8, Taisiya Yakimkova2, Anna Vinitsky8, Gia Ferrara2, Chen Li9, Zhaohua Lu9, Erica C Kaye8, Justin N Baker8, Asya Agulnik2. 1. Brown University, Providence, Rhode Island. 2. Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee. 3. Yerevan State Medical University After Mkhitar Heratsi, Yerevan, Armenia. 4. National Cancer Council, Ulaanbaatar, Mongolia. 5. Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia. 6. Belarusian Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus. 7. N. N. Blokhin Russian Cancer Research Center, Moscow, Russia. 8. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. 9. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Abstract
BACKGROUND: The World Health Organization (WHO) advocates for early integration of palliative care for all children with life-threatening illness. Provider awareness and misperceptions, however, can impede this imperative. In the Eurasian region, little is known about physician knowledge and perspectives on palliative care. METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was developed as an evidence-based and culturally relevant assessment of physician perceptions on palliative care integration into childhood cancer care in Eurasia. Iteratively tested by American and Eurasian palliative care experts, the survey was culturally adapted, translated, and piloted in English, Russian, and Mongolian. The survey was distributed to physicians caring for children with cancer. Fifteen statements were scored in accordance with WHO guidelines to evaluate provider knowledge. The statistical analysis was complemented by a qualitative analysis of open-ended responses. RESULTS: This study received 424 responses from 11 countries in Eurasia. The mean alignment between provider perspectives and WHO recommendations was 70% (range, 7%-100%). Significant independent predictors of higher alignment included country, prior palliative care education, and greater experience with patient death. Respondents primarily described palliative care as end-of-life care and symptom management. Two-thirds of respondents (67%) reported not feeling confident about delivering at least 1 component of palliative care. CONCLUSIONS: This is the first study assessing physician perspectives and knowledge of palliative care in Eurasia and reveals wide variability in alignment with WHO guidelines and limited confidence in providing palliative care. Study findings will inform targeted educational interventions, which must be tailored to the local political, economic, and cultural context.
BACKGROUND: The World Health Organization (WHO) advocates for early integration of palliative care for all children with life-threatening illness. Provider awareness and misperceptions, however, can impede this imperative. In the Eurasian region, little is known about physician knowledge and perspectives on palliative care. METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was developed as an evidence-based and culturally relevant assessment of physician perceptions on palliative care integration into childhood cancer care in Eurasia. Iteratively tested by American and Eurasian palliative care experts, the survey was culturally adapted, translated, and piloted in English, Russian, and Mongolian. The survey was distributed to physicians caring for children with cancer. Fifteen statements were scored in accordance with WHO guidelines to evaluate provider knowledge. The statistical analysis was complemented by a qualitative analysis of open-ended responses. RESULTS: This study received 424 responses from 11 countries in Eurasia. The mean alignment between provider perspectives and WHO recommendations was 70% (range, 7%-100%). Significant independent predictors of higher alignment included country, prior palliative care education, and greater experience with patientdeath. Respondents primarily described palliative care as end-of-life care and symptom management. Two-thirds of respondents (67%) reported not feeling confident about delivering at least 1 component of palliative care. CONCLUSIONS: This is the first study assessing physician perspectives and knowledge of palliative care in Eurasia and reveals wide variability in alignment with WHO guidelines and limited confidence in providing palliative care. Study findings will inform targeted educational interventions, which must be tailored to the local political, economic, and cultural context.
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Authors: Bella S Ehrlich; Narine Movsisyan; Tsetsegsaikhan Batmunkh; Ella Kumirova; Marina V Borisevich; Kirill Kirgizov; Dylan E Graetz; Michael J McNeil; Taisiya Yakimkova; Anna Vinitsky; Gia Ferrara; Chen Li; Zhaohua Lu; Erica C Kaye; Justin N Baker; Asya Agulnik Journal: Cancer Date: 2020-08-19 Impact factor: 6.860