Identifying and changing attitudes toward palliative care: an exploratory study

Research suggests that palliative care is poorly understood and often associated with imminent death (Canny, 2002). This, in turn, can negatively impact upon the transition to palliative care services. The aims of this three phase, multi-method study were to: (1) examine and compare the attitudes of health professionals toward palliative care; (2) examine and compare the attitudes and personal constructs of four key participant groups including patients receiving palliative care services, people living with cancer and the carers of both of these groups; and (3) to examine potential strategies for changing attitudes through education. Phase One involved a detailed assessment of health professionals’ attitudes toward, and understanding of, palliative care by means of a postal survey (182/700) and a small number of one-to-one interviews (n=5). Attitudes toward palliative care, as measured by the Health Professional Attitude Questionnaire (HPAQ), were explained by a number of key factors including: (1) knowledge of palliative care services; (2) relationship with the patient and family; and (3) personal reflection on mortality. Thematic analysis of the qualitative data further illuminated and developed this factorial model. Phase Two utilised one-to-one semi-structured interviews (n=30) and a battery of quantitative measures (n=75) to identify and compare attitudes toward, and experiences of, palliative care amongst patients receiving palliative care services (n=15), people living with cancer (n=25) and the carers of both of these groups (n=35). Repertory grids (n=12) were also used to explore and compare participants’ constructs of palliative care. Thematic analysis of the interview data revealed four key themes and associated subthemes that described patients’ and carers’ attitudes toward palliative care. Within each theme, different perspectives were adopted by each of the participant groups and these were explored and quantified by means of the repertory grid analysis. The findings from Phases One and Two were then used to inform the development of two health professional and patient interventions for Phase\nThree that aimed to: (1) provide information about palliative care services; (2) utilise the patient ‘voice’ and story; (3) focus on the health promoting benefits of palliative care; and (4) demystify hospice, palliative care and the dying process. The study adds to the relatively small pool of evidence in this area and the use of the repertory grid technique, in particular, offers an interesting psychological tool for investigating palliative care research and practice.