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

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          Abstract

          Background

          Dealing with life-limiting illnesses, death, dying and grief, is uncharted territory for medical graduates. It is a field that is heavily influenced by cultural, religio-spiritual and social factors. This adds complexity to palliative and end-of-life-care, which challenges newly qualified physicians and requires the formation of appropriate knowledge, skills, and attitudes in junior doctors. This study aimed to obtain insight into the perspectives, perceived self-efficacy, and preparedness of newly qualified Nigerian physicians in practising palliative care and identify potential variables influencing them.

          Methods

          The study was a cross-sectional, multi-centre survey of newly qualified Nigerian physicians, using semi-structured, in-depth qualitative interviews. The data were analysed by applying content-structuring qualitative content analysis.

          Results

          Forty semi-structured interviews were conducted with medical house officers at two tertiary institutions in Nigeria. The perceived self-efficacy and preparedness of newly qualified Nigerian physicians in practising palliative care were reported to be higher in areas of family involvement, and pain and symptom management than in areas of breaking bad news, prognosis, and diagnosing dying. Major influences on the young physicians’ perceived self-efficacy and preparedness in practising palliative care were socio-economic circumstances of a resource-limited setting and cultural-religious considerations. In addition, the perceived impact of palliative care education and experience was documented.

          Conclusions

          This study offers valuable insights into the perceived self-efficacy and preparedness of newly qualified physicians and reveals the influence of socio-cultural and socio-economic variables in Nigeria. Evidence of the social, cultural, and religio-spiritual dimensions of palliative care is indispensable for culturally sensitive care. These results could aid in the development of appropriate knowledge, skills, and attitudes in newly qualified physicians through culturally and contextually appropriate palliative care training measures. The results may be applicable to other sub-Saharan African settings and may be used to improve future palliative care education, training, and practice.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12904-022-01028-w.

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          A Tong, P SAINSBURY, J. Craig (2007)
          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions

            Katherine Sleeman, Maja de Brito, Simon N Etkind … (2019)
            Summary Background Serious life-threatening and life-limiting illnesses place an enormous burden on society and health systems. Understanding how this burden will evolve in the future is essential to inform policies that alleviate suffering and prevent health system weakening. We aimed to project the global burden of serious health-related suffering requiring palliative care until 2060 by world regions, age groups, and health conditions. Methods We projected the future burden of serious health-related suffering as defined by the Lancet Commission on Palliative Care and Pain Relief, by combining WHO mortality projections (2016–60) with estimates of physical and psychological symptom prevalence in 20 conditions most often associated with symptoms requiring palliative care. Projections were described in terms of absolute numbers and proportional change compared with the 2016 baseline data. Results were stratified by World Bank income regions and WHO geographical regions. Findings By 2060, an estimated 48 million people (47% of all deaths globally) will die with serious health-related suffering, which represents an 87% increase from 26 million people in 2016. 83% of these deaths will occur in low-income and middle-income countries. Serious health-related suffering will increase in all regions, with the largest proportional rise in low-income countries (155% increase between 2016 and 2060). Globally, serious health-related suffering will increase most rapidly among people aged 70 years or older (183% increase between 2016 and 2060). In absolute terms, it will be driven by rises in cancer deaths (16 million people, 109% increase between 2016 and 2060). The condition with the highest proportional increase in serious-related suffering will be dementia (6 million people, 264% increase between 2016 and 2060). Interpretation The burden of serious health-related suffering will almost double by 2060, with the fastest increases occurring in low-income countries, among older people, and people with dementia. Immediate global action to integrate palliative care into health systems is an ethical and economic imperative. Funding Research Challenge Fund, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London.
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              Redefining Palliative Care—A New Consensus-Based Definition

              Lukas Radbruch, Liliana De Lima, Felicia Marie Knaul … (2020)
              Context. The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. Objective. The main objective of this article is to present the research behind the new definition. Methods. The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition. Results. The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC. Conclusion. Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.
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                Author and article information

                Contributors
                Nwabata Oji: nwabata.oji@rwth-aachen.de
                Tonia Onyeka: tonia.onyeka@unn.edu.ng
                Olaitan Soyannwo: folait2001@yahoo.com
                Piret Paal: piret.paal@pmu.ac.at
                Frank Elsner: felsner@ukaachen.de
                Journal
                Journal ID (nlm-ta): BMC Palliat Care
                Journal ID (iso-abbrev): BMC Palliat Care
                Title: BMC Palliative Care
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-684X
                Publication date (Electronic): 4 August 2022
                Publication date PMC-release: 4 August 2022
                Publication date Collection: 2022
                Volume: 21
                Electronic Location Identifier: 141
                Affiliations
                [1 ]GRID grid.1957.a, ISNI 0000 0001 0728 696X, Department of Palliative Medicine, Uniklinik RWTH Aachen, Faculty of Medicine, , RWTH Aachen University, ; Pauwelsstr. 57, 52074 Aachen, Germany
                [2 ]GRID grid.10757.34, ISNI 0000 0001 2108 8257, Department of Anaesthesia / Pain and Palliative Care Unit, College of Medicine, , University of Nigeria, Ituku-Ozalla Campus, ; Enugu, Nigeria
                [3 ]GRID grid.412438.8, ISNI 0000 0004 1764 5403, Hospice and Palliative Care Department, , University College Hospital Ibadan, ; Queen Elizabeth Road, Ibadan, Oyo State Nigeria
                [4 ]GRID grid.21604.31, ISNI 0000 0004 0523 5263, Institute of Nursing Science and Practice, , Paracelsus Medical University, ; Salzburg, Austria
                Article
                Publisher ID: 1028
                DOI: 10.1186/s12904-022-01028-w
                PMC ID: 9351146
                PubMed ID: 35922778
                SO-VID: f2eed1e8-9c38-48cc-838d-97004debb9be
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 19 April 2022
                Date accepted : 19 July 2022
                Funding
                Funded by: RWTH Aachen University (3131)
                Open Access :

                Open Access funding enabled and organized by Projekt DEAL.

                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: newly qualified physicians,palliative care,preparedness,self-efficacy,education,socio-cultural and socio-economic influences,nigeria
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: newly qualified physicians, palliative care, preparedness, self-efficacy, education, socio-cultural and socio-economic influences, nigeria

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