Knowledge of and barriers to palliative care perceived by healthcare providers before and after promotion of the Patient Autonomy Act: A cross-sectional study

Abstract

Background: During the period of 2016~2018, many efforts were put into promoting the Patient Autonomy Act (PAA) in Taiwan, such as nationally sponsoring advertisements, promoting campaigns, and conducting in-service training programs for healthcare providers. However, no study has examined the impacts of promoting the PAA on healthcare providers. This study was designed to investigate healthcare providers’ knowledge of palliative care and perceptions of palliative care barriers before and after promoting the PAA. Methods: A cross-sectional design was conducted in 2013 and 2018 respectively that used a self-reporting questionnaire to examine healthcare providers’ knowledge of palliative care and perceived barriers to providing palliative care. One hospital recruited 277 healthcare providers in 2013 and 222 healthcare providers in 2018 in another hospital. Statistical analyses involved descriptive statistics for demographic characters. Multivariate linear regression analyses were used to identify predictors of knowledge of and perceived barriers to palliative care. A principal component analysis was to identify the most appropriate factorial structure for the contents of knowledge and perceived barriers to palliative care. Results: Three factors related to knowledge of palliative care were identified in both 2013 and 2018 data: ‘policy, regulation, and promotion’, ‘philosophy and treatments’, and ‘myths and misunderstandings’. Study findings in the two periods were similar. As for barriers to providing palliative care, three factors were identified in 2013 of ‘quality palliative care’, ‘palliative care difficulties’ and ‘messaging and communication’, and in 2018 of ‘messaging and information’, ‘knowledge and attitudes’ and ‘quality palliative care’ were identified. Study findings differed between the two periods. Conclusion: After implementation of the PAA, perceived barriers changed. Policies can better reinforce mitigating strategies—including opportunities for education, shared decision-making, and changes in institutions and care systems. Also, assessing barriers creates important opportunities for further research to address the most critical aspects to improving end-of-life care for patients and their families.

The Law and Practice of Advance Directives in Taiwan

“…Preliminary data from Chen et al suggest that the PRAA has had a significantly positive impact on the knowledge of healthcare practitioners, with concepts such as "informed consent" and "decision-making directives" becoming more widely accepted in 2018 (as compared with 2013). 21 In a study conducted among healthcare professionals in the field of nephrology, Chiu et al found that when asked about their knowledge of laws related to ADs, there were three particular areas in which the respondents achieved relatively low scores: (i) understanding of the scope of the HPCA following its revision; (ii) understanding of the matters that one should be aware of when intervening with an AD; and (iii) the difference between an AD and a do-not-resuscitate order. 22 Whilst the latter study does not provide us with sufficient information to properly interpret its results, 23 taken together the findings of the two studies seem to suggest that although efforts to promote the PRAA appear to have had a positive effect on healthcare professionals in Taiwan, there are still specific areas in which their knowledge and understanding remain weak and require further training.…”

Hambatan Perawat Dalam Memberikan Perawatan Paliatif Kepada Pasien: Kajian Literatur Integratif

“…Berdasarkan hasil penelitian yang dikemukakan oleh 10 artikel yang digunakan dalam kajian literatur ini, penulis kemudian secara induktif memformulasikan lima tema yang berhubungan dengan hambatan yang dialami oleh perawat dalam memberikan paliatif yaitu : 1. Hambatan yang dialami oleh perawat dalam memberikan perawatan paliatif adalah kurangnya kemampuan (Hill et al, 2018;Chan et al, 2019); Rivera-Romero et al, 2019;Chan et al,2020;Blaževičienė et al, 2020;Ducharlet et al, 2021;Robertsen & Skär, 2021;Chen et al, 2022) 2. Hambatan yang dialami oleh perawat dalam memberikan perawatan paliatif adalah hambatan psikologis (Chan et al, 2019;Rivera-Romero et al, 2019;Blaževičienė et al, 2020;Ducharlet et al, 2021;Robertsen & Skär, 2021) 3.…”

“…Hambatan yang dialami oleh perawat dalam memberikan perawatan paliatif adalah hambatan psikologis (Chan et al, 2019;Rivera-Romero et al, 2019;Blaževičienė et al, 2020;Ducharlet et al, 2021;Robertsen & Skär, 2021) 3. Hambatan yang dialami oleh perawat dalam memberikan perawatan paliatif adalah hambatan klinis (Chan et al,2020;Bijani & Mohammadi, 2021;Uzelli Yilmaz et al, 2021;Robertsen & Skär, 2021;Chen et al, 2022) 4. Hambatan yang dialami oleh perawat dalam memberikan perawatan paliatif adalah hambatan sumber daya manusia (Hill et al,2018;Chan et al,2020…”

“…Berbagi informasi dan perhatian yang diberikan oleh perawat dalam bentuk pertemuan rutin dapat meningkatkan pengetahuan pasien dan mendorong perubahan perilaku (Mediarti et al, 2020). Salah satu penyebab kesulitan dalam berkomunikasi adaalah kurangnya rasa percaya dari perawat untuk memulai pembicaraan atau memberitahu kepada pasien mengenai berita buruk seperti rencana perawatan akhir hayat, prognosis penyakit, pilihan untuk do not resuscitate (DNR) saat pasien mengalami henti jantung, dan pembicaraan tentang kematian (Chan et al,2019;Ducharlet et al, 2021;Chen et al, 2022).…”

“…Tantangan klinis adalah salah satu tantangan ang dilaporkan oleh perawat dalam memberikan asuhan keperawatan kepada pasien dengan kondisi paliatif (Chan et al,2020;Bijani & Mohammadi, 2021;Uzelli Yilmaz et al, 2021;Chen et al, 2022). Tantangan klinis yang dilaporkan oleh perawat adalah berkaitan dengan pembuatan keputusan klinis.…”