Health workers knowledge and attitude towards palliative care in an emerging tertiary center in south west Nigeria Assessment of caregiving burden of family caregiver of advanced cancer patients and their satisfaction with the dedicated inpatient palliative care provided to their parents

1. Journal Review; Palliative Care
Michael Kelechi Omenugha
Department of Family Medicine
OAUTHC, Ile-ife

2. • Articles
1. Healthcare Workers Knowledge and Attitude
Toward Palliative Care in an Emerging Tertiary
Centre in South-West Nigeria
2. Assessment of Caregiving Burden of Family
Caregivers of Advanced Cancer Patients and
Their Satisfaction with the Dedicated Inpatient
Palliative Care Provided to Their Patients: A
Cross-Sectional Study from a Tertiary Care Centre
in South Asia

3. • Article 1: Healthcare Workers Knowledge and
Attitude Toward Palliative Care in an Emerging
Tertiary Centre in South-West Nigeria
• Authors: Joseph O Fadare, Abimbola M
Obimakinde1, Jide M Afolayan2, Sunday O
Popoola3, Tolulope Aduloju4, Patrick T Adegun3
Departments of Pharmacology,2Anesthesia,3Surgery, Ekiti State University,1Family Medicine and 4Social Welfare, Ekiti State University
Teaching Hospital, Ado-Ekiti, Nigeria
• Year: 2014
• Name of Journal: Indian Journal of Palliative Care

4. Introduction
• Palliative care according to the World Health
Organization (WHO) is the active total care of
patients whose disease is not responsive to
curative treatment.
• The goal of palliative care is achievement of best
quality of life for patients and their families.
• Palliative care aims to affirm life while regarding
dying as a normal process, to provide support to
enable patients to live as actively as possible until
death and to offer support to the family during the
patient’s illness and in their bereavement.

5. • In Nigeria, palliative care is still in its early stage of
development with the establishment of the first
palliative care centre in the oldest teaching and
tertiary hospital in 2003.
• The frequency of chronic non-communicable
diseases as major cause of morbidity and mortality
in developing countries has also emphasized the
need for professionals in the healthcare sector to
acquire knowledge and develop skills in palliative
care.

6. Aim of the Study
• To explore the knowledge and attitude of workers
in a Nigerian tertiary healthcare facility about
palliative care and to inform where gap in
knowledge or understanding may exist

7. Methods
• Study Design: The study was a cross-sectional
• Study Location: Ekiti State University Teaching
Hospital, Ado-Ekiti
• Study Population: The study was conducted
among healthcare workers in the institution.

8. • Sampling Technique: Convenience sampling
method was used.
• Study Duration: One week
• Sample Size: The sample size for the study was
calculated using the following assumptions: 95%
confidence interval, margin of error (5%), level of
response (50%), and population of 400. A sample
size of 197 was calculated and this was increased
to 255 to accommodate possible non-responders.

9. • Data Collection/Instrument:
- The sampling of the different professional classes
(Nurses and Doctors) was done proportionally
according to their respective populations in the
hospital with 120, 100, 20, 10, and 5
questionnaires were distributed to the Nurses,
Doctors, Pharmacists, Social Workers, and Clinical
Psychologists, respectively

10. • The study instrument (questionnaire) was adapted
from one used in a previous study pretested among 10
healthcare workers of the hospital and necessary
adjustments made before being administered to the
participants
• The questionnaire contained socio-demographic
profile of respondents and had sections about the
definition of palliative care, its philosophy,
communication issues, non-pain symptoms of
palliative care, medication use in palliative care, and
context of application.
• All questions or statements were close ended with
three options(Yes, No, and Don’t Know)

11. • Data analysis: The information obtained from the
questionnaire was coded, entered, and analyzed
using IBM SPSS version 19.
- Analysis was done using descriptive statistics to
obtain the general characteristics of the study
participants.
- Chi-square was employed to determine the level
of significance of groups of categorical variables
such as professional cadre, duration of practice, and
gender with P values less than 0.05 considered
significant

12. • Ethical considerations : Ethical clearance was
obtained from the Hospital Research Ethics
Committee before the commencement of the
study

13. Results
• A total of 170 questionnaires were completed and
returned within the stipulated time frame with a
response rate of 66.7%.
• The response rate was different among the
professional groups with Social Workers (100%),
Nurses (83.3%), Doctors (52%), Pharmacists (55%),
and Clinical Psychologists (40%).
• Female respondents constituted the majority with
110 (64.7%) and the mean age of all participants
was 36.6 ± 9.3 years

16. Knowledge about Palliative Care
• The majority (70.5%) of the respondents understood
palliative care to be about pain medicine, 47.9%
thought it to be geriatric medicine while 135 (82.3%)
respondents felt palliative care is about the active
care of the dying.
• Regarding the philosophy of palliative care, 70 (57.9%)
thought that it affirms life while 116 (78.4%) felt
palliative care recognizes dying as a normal process.

18. Conclusion
• The study showed that there are gaps in the
knowledge of healthcare workers in the area of
palliative care.
• There is a need to introduce or reinforce the
study of palliative care in the curriculum of
medical doctors, nurses, pharmacists, and other
healthcare workers both at undergraduate and
postgraduate levels

19. • Article 2: Assessment of Caregiving Burden of Family
Caregivers of Advanced Cancer Patients and Their
Satisfaction with the Dedicated Inpatient Palliative
Care Provided to Their Patients: A Cross-Sectional
Study from a Tertiary Care Centre in South Asia
• Authors: Ajay Kumar Kondeti1, Ambedkar Yadala1, N.
Rajya Lakshmi1, C.S.K. Prakash1, Gayatri Palat2, Shoban
Babu Varthya3
1.Department of Radiotherapy and Oncology, Government General Hospital, Kurnool Medical College, Kurnool, Andhra Pradesh, India. 2.Pain and Palliative Medicine, MNJ Institute of Oncology and RCC,
Hyderabad, India, and the Director, PAX Asia Program, Two Worlds Cancer Collaboration, Canada. 3. Department of Pharmacology, All India institute of medical sciences, Jodhpur, Rajasthan, India.
• Year: 2021
• Name of Journal: Asian Pacific Journal of Cancer
Prevention

20. Introduction
• Cancer is a chronic disease, which usually lasts for one
to few years and requires long term medical care.
• It also restricts the daily activities of sufferers.
• Thus, it brings about considerable changes, physically,
mentally, socially as well as spiritually, in the lives of
both cancer patients and their family caregivers (FCs).

21. • FCs are relatives, friends, or neighbours who aid
the patients without being paid
• FCs play a vital role in ensuring proper health care
to their advanced cancer patients, thus impacting
the patient’s course of disease progression,
survival, and quality of life.
• This often results in psychological burden on both
patients and FCs. They tend to suffer in relation to
each other.

22. Aim of the Study
• To assess the caregiver burden and satisfaction of
the FCs of advanced cancer patients with the
palliative care services provided in a dedicated IPC
unit of a tertiary care centre in India, South Asia .

23. Methods
• Study Design: This study was a hospital-based
cross-sectional one.
• Study Location: In-patient palliative care(IPC) unit,
of The Government General Hospital (GGH),
Kurnool Medical College, Kurnool, Andhra
Pradesh, India
• Study Population: FCs of advanced cancer patients
referred to the IPC unit.

24. • Sample size:
- The sample size was calculated based on a previous
study done by Kim Y et al. in which the proportion of
caregivers with high burden was found to be 67.3%
(Kim et al., 2008).
- Hence, with 95% confidence interval and assuming
10% non-response rate, a sample size of 200 was
obtained.

25. • Study Duration: March 2020 to November 2020.
Enrolment of the FCs for the study was done within
one week after their patient’s admission.
• Ethical Considerations/ Clearance: Ethics
Committee of Kurnool medical college, granted the
necessary permission to conduct the study (KMC-
IEC No. 110/2020).

26. • Inclusion criteria:
1. Unpaid FCs of terminally ill cancer patients
2. Aging more than 18 years
3. Being able to communicate in either vernacular
language (Telugu) or English.
- FCs who were primarily assisting patients at home
were given preference.

28. • Data collection tools :
- To assess FCs caregiver burden and satisfaction with
palliative care provided to their relatives, FCs completed the
following questionnaires.
1. Zarit Caregiver Burden Interview Short Form (ZBI-12):
- ZBI-12 is the short version of ZBI and consists of 12 items in
two domains, namely personal strain (3 items) and role strain
(9 items).
- Each question is scored through five-point Likert scale
ranging from 0 to 4 (never to almost always).
- High score represent higher feel of burden.
- The following score range depicts the level of burden: 0 to
10 none to mild burden, 11 to 20 moderate burden, and
above 20 high burden.

29. 2. Family Carer Satisfaction with Palliative Care scale
(FAMCARE-2):
- FAMCARE-2 scale is a revised version of the FAMCARE
tool used to measure family satisfaction with
advanced cancer care, especially in inpatient settings.
- It consists of 17 items scored on a fivepoint Likert scale
ranging from “very satisfied” to “very dissatisfied”.
- Higher scores denote better satisfaction with palliative
care services among FCs.

30. - It includes four subscales, namely the management
of physical symptoms and comfort (items), provision
of information (4 items), family support (4 items),
and patient psychological care (4 items)
• The vernacular (Telugu) language versions of ZBI-
12 and FAMCARE-2 questionnaires were pretested
for translational validity through forward and
backward translation

31. • Data Analysis
- Descriptive analyses were applied to evaluate
baseline demographics.
- Student t-test or One- way ANOVA was applied for
analysing the difference between ZBI-12 and
FAMCARE-2 scale scores regarding demographic
variables.
- Multivariate analysis was performed to analyse the
associations between demographic variables and
mean ZBI-12 and FAMCARE-2 scale scores.

32. - All significance tests were two-tailed using a
significance level of p< 0.05.
- Data analysis was done using SPSS Version 23
(IBMCorp. Released 2015. IBM SPSS Statistics for
Windows, Version 23.0. Armonk, NY: IBM Corp.)

33. Results
• The results showed that 59.7% of FCs were less
than 60 years of age and the mean age of the FCs
was 51.5 years (SD 14.20 and ranging from 19 to
74).
• Most of the FCs were male (52.1%), non-spousal
caregivers (61.6%), and married (91%).
• Most of them belonged to majority Hindu religion
(64.9%) and non-general backward communities
(60.2%).

34. • Majority of them were literate (53.1%), employed
(77.7%), below poverty line (BPL) families (69.7%),
and from rural regions (78.7%).
• Head and neck cancers constitute majority of
cases (41.2%) diagnosed in their relatives
• The summative mean ZBI-12 score for FCs was
20.26±5.92 (SD), suggesting moderate to high
caregiving burden among FCs.

35. • Statistically significant higher ZBI-12 scores were
observed for FCs who belonged to below poverty
line BPL families (p=0.025), suggesting higher
caregiving burden among this lower income
group.
• The summative mean FAMCARE-2 scale score was
74.01±4.34 (SD).

36. • Among the subscales, the highest mean score
was allocated to subscale of management of
physical symptoms and comfort, with overall
mean of 20.93±1.69 (SD).
• FAMCARE-2 scores were lower in lower income
group, that is BPL families, but it was not
statistically significant (p=0.138).

37. • No significant association was observed among
the other FC groups, regarding FAMCARE-2 scores,
suggesting generally high level of satisfaction with
palliative care provision among the FCs
irrespective of their demographic characteristics

38. • Multivariable regression results showed no
significant association between FAMCARE-2 scores
and demographic variables, such as age, sex,
education level, income, and social status with
respect to the satisfaction level.

42. Conclusion
• Moderate to high caregiving burden was observed
among FCs of advanced cancer patients receiving
palliative care services in IPC in the study.
• Also significantly higher caregiving burden was
observed among the lower income FCs.
• These findings indicated the importance of regular
assessment, finding the causal factors, and addressing
these concerns through targeted interventions as
early as possible.

43. • The FCs satisfaction with palliative care provided
to their patients was high across all demographic
groups, even though these groups showed
moderate to high caregiving burden.
• With the regular employing of tools like
FAMCARE-2 scale, we may assess both
quantitative and qualitative functioning of
palliative care services.