Evaluation of An Educational Intervention in Palliative Care for Family Doctors in Vietnam

Background
The national strategy for palliative care in Vietnam is to integrate palliative care to cancer care and primary care. In Camau province, 70% of rural family doctors are involved in palliative care provision for cancer patients in rural areas. However, 85% have no palliative care training before or after graduation.
Objectives
• To evaluate the outcomes of an educational intervention in palliative care for rural family doctors in terms of perceived knowledge, confidence and practice behaviour.
• To explore and compare views and experiences of hospitalised patients with those receiving palliative care in the community.
Methodology
A mixed methods approach was conducted using a pre- and post-workshop design. Doctors completed pre- and post-workshop questionnaires, and patients in two settings (hospital and home) participated in semi-structured interviews. Doctor data was analysed using an independent sample t-test to compare scores of knowledge and confidence before and after the workshop. Thematic analysis was used to analyse patient interviews.
Findings
The overall response rate from doctors was 67%. Pain management, fatigue and communication were the most requested topics for the education workshop (85%, 50%, 45%). As a result of the workshop, one-third indicated an increase in morphine prescribing and caseloads in their workplace. There was a statistically significant increase in scores of knowledge (p = 0.004) and confidence (p <0.001) after workshop.
Patients’ choice of place of care was based on their satisfaction with the care, relationship with staff, the severity of symptoms and convenient access. Hospitalised patients claimed that local family doctors lacked expertise and enthusiasm in palliative care provision. The local palliative care service was perceived as acceptable by patients interviewed at home.
Conclusions
The multi-faceted intervention improved the knowledge, confidence and behaviour of family doctors. Satisfaction with generalist palliative care from the trained doctors was indicated by patients interviewed in the community.