Email this article US, Russian and Indian physician perspectives regarding end of life care
- Authors: Jackson J.G.1, Raj S.M.2, Matveeva Y.1, Xu Y.1, Jogerst G.J.1
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Affiliations:
- University of Iowa
- Kasturba Medical College
- Issue: Vol 24, No 3 (2020)
- Pages: 11-20
- Section: Original studies
- URL: https://journals.eco-vector.com/RFD/article/view/41869
- DOI: https://doi.org/10.17816/RFD41869
- ID: 41869
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Open Access
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Abstract
Aim. To compare US, Russian and Indian primary care physicians’ attitudes, comfort and experiences providing palliative care.
Design. Cross sectional survey.
Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India.
Participants. Primary care physicians.
Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores.
Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p < 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p < 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p < 0.001. Patient should be informed (US vs Russia vs India) of terminal illness “Always” (74% vs 31% vs 33%) p < 0.001, “If Asked” (9% vs 64% vs 12%) p < 0.001 or “Physician’s Judgement” (15%, 5%, 54%) p < 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care “Often or Always” (63% vs 36% Russian v 21% Indian) p < 0.001.
Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.
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About the authors
James G. Jackson
University of Iowa
Author for correspondence.
Email: jacksonjgil@gmail.com
MD, Global Mental Health Fellow UCSF/HEAL Initiative
United States, Iowa City, IASheetal Moolambally Raj
Kasturba Medical College
Email: sheetal.raj@manipal.edu
Associate Professor, Department of Medicine
India, MangaloreYulia Matveeva
University of Iowa
Email: yulia-matveeva@uiowa.edu
Clinical Assistant Professor, Department of Family Medicine
United States, Iowa City, IAYinghui Xu
University of Iowa
Email: yinghui-xu@uiowa.edu
Biostatistician Manager, Department of Family Medicine
United States, Iowa City, IAGerald J. Jogerst
University of Iowa
Email: gerald-jogerst@uiowa.edu
Professor Emeritus Departments of Family Medicine and Psychiatry
United States, Iowa City, IAReferences
- World Health Organization. Global health and aging [cited 4.01.2020]. Available from: http://www.who.int/ageing/publications/global_health.pdf.
- World Health Organization. Worldwide Palliative Care Alliance. Global atlas of palliative care at the end of life [cited 2.06.2020]. Available from: https://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf.
- Matchim Y, Aud M. A Cross-cultural Comparison Between the United State and Thailand. J Hosp Palliat Nurs. 2009;11(5):262-268.
- Herbstsromer R, Stahl S. Cross-cuttural experiences of hospice and palliative care services: a thematic analysis. Omega (Westport). 2020;30222820904205. https://doi.org/10.1177/0030222820904205.
- Csikos A, Csikos A, Mastrojohn J, et al. Physicians’ beliefs and attitudes about end-of-life care: A comparison of selected regions in Hungary and the United States. J Pain Symptom Manage. 2010;39(1):76-87. https://doi.org/10.1016/j.jpainsymman.2009.05.019.
- Jogerst G, Xuet Y, Jackson JG, Matveeva Yu. US and Russian physician perspectives regarding end of life care. Arch Gerontol Geriatr Res. 2020;5(1):002-006. https://doi.org/10.17352/aggr.000014.
- Snyder S, Hazelett S, Allen K, Radwany S. Physician knowledge, attitude, and experience with advance care planning, palliative care, and hospice: results of a primary care survey. Am J Hosp Palliat Care. 2013;30(5):419-424. https://doi.org/10.1177/1049909112452467.
- Litwin MS. How to assess and interpret survey psychometrics. Thousand Oaks, Calif; London: SAGE; 2003. Р. 33-34.
- Pope C, Mays N. Reaching the parts other methods cannot reach: An introduction to qualitative methods in health and health services research. BMJ. 1995;311(6996):42-45. https://doi.org/10.1136/bmj.311.6996.42.
- World Health Organization. The health workforce in India [cited 3.01.2020]. Available from: https://www.who.int/hrh/resources/16058-health-workforce-India-web.pdf.
- Ramakrishnan A, Sambuco D, Jagsi R. Women’s participation in the medical profession: insights from experiences in Japan, Scandinavia, Russia, and Eastern Europe. J Womens Health (Larchmt). 2014;23(11):927-934. https://doi.org/10.1089/jwh.2014.4736.
- Association of American Medical Colleges. Active physicians by sex and specialty, 2017 [cited 4.11.2020]. Available from: https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2017.
- Kulkarni P, Kulkarni P, Anavkar V, Ghooi R. Preference of the place of death among people of pune. Indian J Palliat Care. 2014;20(2):101-106. https://doi.org/10.4103/0973-1075.132620.
- Shih CY, Hu WY, Cheng SY, et al. Patient preferences versus family physicians’ perceptions regarding the place of end-of-life care and death: A nationwide study in Taiwan. J Palliat Med. 2015;18(7):625-630. https://doi.org/10.1089/jpm.2014.0386.
- Sadhu S, Salins NS, Kamath A. Palliative care awareness among indian undergraduate health care students: a needs-assessment study to determine incorporation of palliative care education in undergraduate medical, nursing and allied health education. Indian J Palliat Care. 2010;16(3):154-159. https://doi.org/10.4103/0973-1075.73645.
- Butola S. A study on knowledge, attitude, and practices regarding palliative care among doctors in Border Security Force. Progress Palliative Care. 2014;22(5):272-279. https://doi.org/10.1179/1743291X14Y.0000000090.
- Macaden SC, Salins N, Muckaden M, et al. End of life care policy for the dying: Consensus position statement of Indian association of palliative care. Indian J Palliat Care. 2014;20(3):171-181. https://doi.org/ 10.4103/0973-1075.138384.
- Stanford School of Medicine. Health and health care of Asian Indian American Older Adults [cited 2020 April 1]. Available from: https://geriatrics.stanford.edu/ethnomed/asian_indian.html.
- Willmott M, Kingdon A, Barclay S. Comparing Kerala, India and Cambridge, the UK: A study of doctors’ and nurses’ attitudes towards palliative care. BMJ Support Palliat Care. 2015;5(5):468-470. https://doi.org/ 10.1136/bmjspcare-2014-000762.
- Ghoshal A, Salins N, Damani A, et al. To tell or not to tell: Explorijng the preferences and attitudes of patients and family caregivers on disclosure of a cancer-related diagnosis and prognosis. J Glob Oncol. 2019;5:1-12. https://doi.org/10.1200/JGO.19.00132.
- Ang GC, Zhang D, Lim KH. Differences in attitudes to end-of-life care among patients, relatives and healthcare professionals. Singapore Med J. 2016;57(1):22-28. https://doi.org/10.11622/smedj.2016008.
- Morita T, Oyama Ya, Cheng SY, et al. Palliative care physicians’ attitudes toward patient autonomy and a good death in East Asian countries. J Pain Symptom Manage. 2015;50(2):190-199.e1. https://doi.org/10.1016/ j.jpainsymman.2015.02.020.
- Vallath N, Rajagopal MR, Perera S, et al. Access to pain relief and essential opioids in the WHO South-East Asia Region: Challenges in implementing drug reforms. WHO South-East Asia J Public Health. 2018;7(2):67-72. https://doi.org/10.4103/2224-3151.239416.
- Rajagopal MR, Joranson DE, Gilson AM. Medical use, misuse, and diversion of opioids in India. Lancet. 2001;358(9276):139-143. https://doi.org/10.1016/s0140-6736(01)05322-3.
- Rajagopal MR. Methadone is now available in India: Is the long battle over? Indian J Palliat Care. 2018;24(Suppl 1):S1-S3. https://doi.org/10.4103/IJPC.IJPC_201_17.
- Morley G, Ives J, Bradbury-Jones C, Irvine F. What is ‘moral distress’? A narrative synthesis of the literature. Nurs Ethics. 2019;26(3):646-662. https://doi.org/10.1177/0969733017724354.
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