Palliative Care Knowledge and Attitudes

Knowledge was measured by adapting the Palliative Care Knowledge Test (PCKT) questionnaire [10 (link)]. The questionnaire has twenty items and is divided into five domains: philosophy (items 1 and 2), pain (items 3 to 8), dyspnoea (items 9 to 12), psychiatric problems (items 13 to 16), and gastrointestinal problems (items 17 to 20). Participants answer every question as either “true”, “false”, or “unsure”. One point is given for a correct answer and zero points for incorrect and “unsure” answers. The total score ranges from 0 to 20 and is converted into a mean and standard deviation (SD). A higher score indicates higher knowledge. The translated English version was used in this study and a few modifications were made to suit the local setting. Three items regarding specific drug use (pentazocine and buprenorphine hydrochloride) were substituted since these drugs are not widely used in Malaysia. Item number four, pentazocine, was changed to oxycodone as the latter is more commonly used for pain control in Malaysian settings. Item number six, which is “The effect of opioids should decrease when pentazocine or buprenorphine hydrochloride is used together after opioids are used”, was changed to “Even if breakthrough pain occurs when opioids are taken on a regular basis, the next dose should not be given earlier than scheduled.” Item number 12, “Anticholinergic drugs or scopolamine hydrobromide are effective for alleviating bronchial secretions of dying patients” was changed to “Evaluation of dyspnoea should be based on the subjective report of patients”. Preliminary testing of the questionnaire was done in a pilot study yielding a Cronbach alpha of 0.7.
Attitudes were measured using Frommelt Attitude Toward Care of the Dying-form B (FATCOD Form B) [11 ]. This form has been used and evaluated for validity and reliability, and it has demonstrated an interrater agreement of 1.0 and a Pearson’s Coefficient of 0.93 for test-retest reliability. FATCOD Form B consists of 30 Likert-type items scored on a five-point scale from 1 (Strongly Disagree), 2 (Disagree), 3 (Uncertain), 4 (Agree), to 5 (Strongly Agree). The instrument is made up of an equal number of positively and negatively worded items. Items 1, 2, 4, 16, 18, 20, 21, 22, 23, 24, 25, 27, and 30 are positively-worded statements. All others were negatively worded. The total score, ranging from 30 to 150, was converted into a mean and standard deviation with higher scores indicating more positive attitudes.