Challenges experienced by health care providers working in both hospital-based palliative care units in Dhaka City: A multi-center based cross-sectional study
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Background: Palliative care is paramount in the modern clinical field worldwide. However, in Bangladesh, its acceptance is limited compared to other related sectors, despite the country suffering from a huge burden of life-limiting diseases. Besides, PC teams and their approach to care are entirely different from the conventional clinical approach. This study aimed to explore the challenges faced by healthcare providers working in the palliative care unit in Bangladesh, including all groups. Design: This was a cross-sectional descriptive survey involving palliative care providers. Methods: A self-administered pre-tested questionnaire was used for data collection. Data was analyzed using descriptive statistics and Chi-square at p <0.05. Result: The mean age of the respondents was 33.59 ± 8.05 years, and barely most (82.5%) had served for 7-9 years. More than half (51%) of doctors and 31 % of nurses claimed patient agitation as a challenge. Almost all groups of respondents exhibit ethical dilemma as a barrier, although a significant relationship was found between professional level and ethical dilemma. More than half of doctors (51%), 41.5% of nurses, and 29.5% of PCA-ward staff mentioned the lack of telemedicine facilities as a challenge. Nearly half (47.1%) of doctors and nurses claimed that patients’ families had made patient care difficult, on the other hand, PCA-ward staff (70%) group ignorance of family did the same thing. Opioid phobia of other health professionals restricted the growth mentioned by the majority of all four groups of respondents. A significant relationship was found between limited dose formulation and experience of HPs (p<0.07). At the institutional level, 93.3% of nursing staff agreed that the lack of supporting staff was a drawback. A significant relationship was also found between the type of institution and the lack of a support system to conduct home-based care (p<0.002). Moreover, the majority (83.3%) of PCA-WS exhibit a lack of career development opportunities (p<0.001) as a barrier, besides, more than 7 out of 10 doctors (7.2%) felt social discrimination as a challenge(p<0.001). Conclusion: Introducing new concepts comes with obstacles, but proper planning and awareness can make it necessary. Incorporating it into primary healthcare can create new job opportunities and increase familiarity among the general population. Training healthcare professionals on opioid handling can also increase its acceptance.
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The study conducted was a descriptive cross-sectional study. The sample was selected using the census method, and 160 participants willingly took part in the study, although the estimated staff number was 178. The study was conducted between January and December 2022. The study population consisted of licensed healthcare providers of both sexes, including doctors, nurses, palliative care assistants, ward staff, and home-based program staff who had been actively involved in providing palliative care to patients for at least one year at BSMMU, Dhaka Medical College & Hospital, Delta Medical College & Hospital, and National Institute of Cancer Research Hospital in Dhaka city, Bangladesh. In addition to these hospital settings, data was also collected from community-based palliative care projects of BSMMU in collaboration with WHPCA in Korail and Narayanganj City Corporation. Physically and mentally unfit providers were excluded from the study. Data was checked in the field immediately after the interview and information gathering. The study used face-to-face semi-structured interviews based on specific variables. The questionnaire was developed in English, translated into Bangla, and interviews were conducted privately with voluntary participation. Data processing involved categorizing, coding, summarizing, and entering data with SPSS software. Each interview lasted approximately 30 minutes. Categorical and numerical variables were categorized separately. Each "No" answer was given a score of "0," and each "Yes" answer was given a score of "1." Some answers had the option "Unsure" or "Undecided," which were given a score of "2." Descriptive statistics were done for qualitative and quantitative variables, and inferential statistics were used to establish relationships among variables.