Senthil Paramasivam Kumar

Address for correspondence* Senthil Paramasivam Kumar Associate professor, Dept of Physiotherapy,Kasturba Medical College (Manipal University),Mangalore-575001, India. E-mail : [email protected] e ISSN: 2277-7253 © 2012 Asian J Med Res Despite recent advances in assessment and management, major issues relating to palliative care for patients and their families remain unanswered. Several challenges face researchers in this area. There were administrative issues, including historical development, funding, academic recognition, integration of [15] services, and cooperation among different centres. The one single-most influencing factor for the abovementioned sequelae of challenges facing palliative care practice [16] [17] and research is attitudes and change of attitudes by itself could be the first step that can lead to effective and efficient palliative care education, practice, research and administration. Evidence-based palliative care (EBPC) involved integrating effective research findings with clinical expertise and patient preferences towards better individualized provision of [18] palliative care for patients. One of the main causes for lack of quality in provided care for terminally ill patients in an era of evidence-informed/ evidence-based practice is the lack of [19] adequate research evidence and this may be due to four possible reasons: lesser studies being conducted on such population, publication of lesser number of studies, sociocultural and ethical [20,21] issues and reporting characteristics of such studies. Previously published studies on analysis of palliative care journals were on reporting of moral problems (ethical [22] [23] issues), euthanasia, chaplains and community-based [24,25] [25-27] [28] clergy, and, religion and spirituality, cancer pain, [29] [30] pediatric palliative care and quality of life. The objective of this paper was to perform a quantitative analysis of research articles on 'attitudes' published in palliative care journals over the past five years. Subjects and Methods Search strategy and criteria Journals indexed in MEDLINE with name 'palliative' st were included and searched that were published from 1 Dept of Physiotherapy,Kasturba Medical College (Manipal University),Mangalore-575001, India Private practititoner and freelancing physiotherapist,Mangalore. th December 2006 till 30 November 2011 for English abstracted papers with ['attitudes'] in [title] of the paper. Data synthesis The total number of articles in all the selected journals was taken as N. The number of included articles (N ) based on 1 search criteria were compared with total number of published articles (N) to obtain reporting rates (N /N%) for each journal. 1 The journals were categorized broadly into multidisciplinary, medical, nursing and other (social work) categories of palliative care journals. The included studies were categorized under assessment and treatment studies and then subcategorized into original articles and review articles. The original articles were then again grouped into qualitative and quantitative studies and both of them were then sub-grouped based upon study designs. Number of articles reported in each of the final subgroups was computed and compared. The procedure of data synthesis is explained in the schematic flowchart (figure-1). Simultaneously categorical grouping was extended to target populat ion (healthcare professionals/students and patients/caregivers). Data analysis Descriptive analysis using frequencies for number of studies with respective percentiles was used for reporting characteristics and was done using 95% confidence interval by SPSS for Windows version 11.5 (SPSS Inc, IL). RESULTS Overall journals' characteristics The study included twelve palliative care journals with a total number of 2854 articles. On first level, there were 59 abstracts that were included for final analysis. There were 59 articles that were on 'attitudes' thus making the overall reporting rate to be 2.06% (figure-2). The twelve journals were AJHPCAm J Hosp Palliat Care; BMCPCBMC Palliat Care; COSPCCurr Opin Support Palliat Care; IJPCIndian J Palliat Care; IJPNInt J Palliat Nurs; JHPNJ Hosp Palliat Nurs; JPPCPJ Pain Palliat Care Pharmacother; JPCJ Palliat Care; JPMJ Palliat Med; JSWELPCJ Soc Work End Life Palliat Care; PMPalliat Med; and, PSCPalliat Support Care. [31-39] Individually AJHPC had 9 articles, BMCPC had [40-42] [43] three articles, COSPC had one article, IJPC had four [44-47] [48-55] [56,57] articles, IJPN had eight articles, JPC had two articles, [58-68] [69] JPM had 11 articles, JPPCP had one article, JSWEOLPC [70] [71-84] had one article, PM had 14 articles, and PSC had five [85-89] articles on 'attitudes.' Also refer to table-1 for respective reporting rates for journals and figure-3 for comparison of number of 'attitudes' articles and other articles between the journals. Of the selected journals, seven were multidisciplinary (AJHPC, BMCPC, COSPC, IJPC, JPC, JPPCP, PSC), two were medical (JPM, PM), two were nursing (IJPN, JHPN), and one was other (social workJSWEOLPC). The reporting rate for articles in nursing journals was highest at 2.25% (8/355) followed by multidisciplinary journals at 2.15% (24/1113) and medical journals at 1.94% (26/1334). Of all the 59 included studies, there were 56 original [31-42,44-68,70,71,73-89] [43,69,72] articles. and three review articles. The two systematic reviews were on artificial hydration by Raijmakers et [43] 72 al and on euthanasia by McCormack et al respectively, while [69] the third review was a narrative review on cultural transformation in pain management. The 57 original articles comprised of 55 [31-42,45-68,70,71,73-80,82-89] assessment/evaluation studies and two [44,81] treatment/intervention studies. Of the two intervention 153 44 81 studies, palliative care training and end-of-life education were 44 reported for their effects on attitudes in physiotherapy students 81 and medical students/healthcare workers towards palliative care [44] [81] and death respectively. The 55 assessment/evaluation studies included three [33,49,88] [31,32,34-42,45-8,50quantitative studies and 52 qualitative studies. 68,70,71,73-80,82-7,89] The three quantitative studies were development and validation of measurement toolsEuthanasia attitude scale (EAS) [33] 88 and Life attitudes profile-revised, and application of EAS in 49 Flemish nurses. All the 52 qualitative (assessment) studies were [31,32,34-42,45-8,50-68,70,71,73-80,82-7,89] cross-sectional studies. The 52 cross-sectional (assessment, qualitative) studies 3 1 , 6 7 , 7 9 comprised of studies targeting care managers, [32,80,89] [34,35,48,56,64,73,74] generalpopulation, carestaff, healthcareprofessio [ 3 5 , 5 0 , 5 7 , 7 1 ] [ 3 6 , 3 9 , 4 5 , 4 7 , 5 2 , 5 8 , 6 2 , 6 6 , 6 8 , 7 2 , 7 5 , 7 6 , 7 8 , 7 9 , 8 5 , 8 6 , 8 9 ] nals, physicians, [37,39,45,48,51,52,53,55,70,77,79,82,85,87] [38,41,60,63,73] nurses, patients, medical [40,59,61,65,83,84] [42] [46,54] students, medical ethics experts, nursing students [70] and social workers. The comparison of number of studies based upon target sample populations is shown in figure-4. More studies were reported on physicians (27%) followed by nurses (22%) and care staff (11%). DISCUSSION This review is the first of its kind focused on quantitative analysis of palliative care journals for their reporting on 'attitudes'. Attitude is a psychological attribute of the person or people under consideration which is an integrated function of biopsychosocial factors related both to personal and professional roles of the [90] individual(s). Although broadly categorized into positive and negative attitudes, it is often an umbrella term used and grouped together with knowledge, beliefs, needs and experiences. This study found a reporting rate lesser than that of previous quantitative analyses on cancer pain, pediatric palliative care and quality of life. The reason might be attributed to the lesser emphasis on psychosocial factors in palliative care research compared to disease or outcomes. This opens up new opportunities for further research in palliative care utilizing attitudes as outcomes in prospective longitudinal intervention studies. Amongst a few limitations such as the study sample included only palliative care journals indexed in MEDLINE, which it is assumed to be the most authentic and most widely searched database till date. Whether palliative care professionals refer palliative care journals the most, is another topic to be explored in future research. The search strategy used in this study would be assumed to be valid since there existed no previous validated methods to search palliative care journals. This study used the search terms in title, whilst using them in title OR abstract would have yielded different results. However, if the term is not listed in title, we could least assume that it was emphasized in the study per se. The search strategy included 'English' articles as part of per-protocol method and not for excluding non-English journals/ articles. There are also no non-English articles and/or journals in the field of palliative care in PubMed. Whilst this study found palliative care journals' reporting rates, findings from other journals (medical, psychology, nursing and oncology) might be quite different and comparison between such journal categories would provide directions for an evidencebased palliative care clinician and an informed patient/caregiver equally as well. Studies on family caregiver attitudes were absent, and this is somewhat surprising when a greater emphasis was 91 given to caregiver knowledge. Future research on reporting education and/or training programs would enable curricular Asian J Med Res |Oct-Dec 2012 | Vol-1 | Issue-4