**3. Health care professional's attitude about palliative care for cancer patients**

#### **3.1 Introduction about supportive and palliative care among cancer patients**

Palliative care (PC) is a specialized medical care for people living with a life terminal illness and provides relief from the symptoms and stress [29] including people who have stopped treatment to cure or control their disease [30]. Anyways the goal of PC is to improve quality of life for both the patient and their family members.

#### *Supportive and Palliative Care Attitude for Cancer Patients DOI: http://dx.doi.org/10.5772/intechopen.104757*

PC and SC (supportive care) are appropriate for not only cancer patients but also those with serious illness, regardless of whether or not they are receiving life-limiting therapies and can be delivered in inpatient and outpatient settings appropriate at any age, at any stage and can be provided together with curative treatment [31]. Palliative care incorporates the whole spectrum of care-medical, nursing, psychological, social, cultural, and spiritual [32]. A holistic approach, including these extensive attitudes of care, which is a good medical practice and in palliative care it, is essential [32]. Palliative care, which has historic roots in end-of-life and hospice care, now has established itself as a medical specialty dedicated to helping patients with serious illness live as well as possible for as long as possible [2].

Supportive care (SC) in cancer is defined as "the prevention and management of the adverse effects of cancer and its treatment and includes management of physical and psychological symptoms and side effects across the continuum of the cancer experience from diagnosis through treatment to post-treatment care [33]. Enhancing rehabilitation, secondary cancer prevention, survivorship, and end-of-life are care integral to supportive care [33]. SC is also helping manage the common side effects of cancer treatment, thereby enhancing the quality of life in patients receiving cancer therapy.

Supportive care is a necessary service for those with cancer to meet their physical, emotional, social, psychological, informational, spiritual, and practical needs during the diagnostic, treatment, and follow-up [34, 35], encompassing issues with survivorship, palliative care, and bereavement [35]. The SC of patients with cancer improves patient's quality of life, increases the patient's survival rate and reduces side effects caused by treatment of a disease [1].

Studies have shown that patients and providers have a more favorable impression of the term "supportive care" than "palliative care." As a result of tremendous advances in the treatment of early and advanced stages, more patients live with a diagnosis of cancer for longer periods of time. Despite improvements in cancer care, however, many patients continue to experience side effects from both their disease and treatment [2].

Both "Palliative care" and "Supportive care" can be given at any point during a person's illness to help them feel more comfortable [15].

PC and SC both work together as a team that focuses on quality of life and holistic services to patients and their family members. Abundant data now demonstrate that Palliative and Supportive care is beneficial to patients and their families and should be more incorporated into cancer care. In particular, patients with advanced cancer have to deal with many problems during the progression of the disease such as pain, fatigue, energy depletion, and loss of appetite, along with physical symptoms of cancer itself. In addition, cancer patients have a variety of psychological symptoms such as being suggestive anxiety, depression, and sleep disorders [34].

Anderson who is a Texas University physician found that the term "palliative care" was perceived as more distressing and as reducing hope for patients and families. They preferred the name "supportive care" and stated that they would be more likely to refer patients to a service named "supportive care" [21]. After the institution changed the name of both inpatient and outpatient services from "palliative care" to "supportive care" in 2007, they found a 41% increase in consults.

In addition, registration of outpatient palliative care services decreased from 13.2 months to 9.2 months, indicating that patients were being seen earlier in the disease process [36]. Researchers from the University of Pittsburgh interviewed patients with advanced cancer and found that patients had a more favorable impression of the term "supportive care" than "palliative care" [37]. The fields of "supportive care" and "palliative care" in oncology emerged from separate patient needs, have since evolved and are now intertwined. Supportive care arose specifically to combat toxicities of cancer treatment [2].

No significant difference was found between specialists who perceived the terms "palliative care" and "supportive care" [38].

#### **3.2 Health care professional's attitudes towards cancer patients**

Groot et al., [39] determined three-common barriers to perceiving palliative care services including:


In Gibbs et al., [40] determined common barriers including lack of adequately trained palliative care physicians, nurses, and social workers; lack of knowledge among patients and families, and lack of training opportunities for existing healthcare team members, all of which add to implementation difficulties [41].

Cultural, ethnic, and religious beliefs help to shape people's attitude towards and dying [42]. Cancer patients have physical (physical symptoms), social (social isolation), functional (activity), spiritual (spiritual abandonment), emotional (sadness, anxiety.) wellbeing needs.

Health care professionals (HCP) have to provide positive attitudes towards different needs during an appropriate time for cancer patients. Additionally, cultural values and beliefs play a role in Health care professional's attitudes towards palliative care patients [12, 42, 43].

Mc Loughlin KE studied the healthcare professional's attitudes towards palliative care and caring for dying patients and a number of countries used her studies to measure healthcare professional attitudes including Germany, Denmark, the UK, the Netherlands, Wales, California America [44] and Texas [35].

In 2007 researcher's evidence showed that the attitude of healthcare professionals can change through the provision of palliative care education [45, 46] and through providing palliative care.

A health care professional has a more positive attitude to care for these people which is also associated with less fear and avoidance of death, anxiety, and stress [9, 22–24].

Healthcare professionals have different attitudes towards dying patients, for example, oncologists and nurses had more positive attitudes towards PC and caring for dying patients than other healthcare professionals.

Dr. Kathleen found 5 factors influencing health professionals' attitudes towards palliative care (as shown in **Figure 2**).

Below including


*Supportive and Palliative Care Attitude for Cancer Patients DOI: http://dx.doi.org/10.5772/intechopen.104757*

**Figure 2.**

*Factor of attitudes towards palliative care uploaded by Mcloughlin [44].*


They reflect more on existential matters such as nurses being more likely to agree that dealing with a dying patient made them more aware of their own feelings about death than doctors did. In general, nurses were more positive than doctors about palliative care.

In one study of the Danish healthcare professionals, nurses were more likely than doctors to agree that palliative care was a rewarding part of their work and was less likely to prefer to leave the care of dying patients to others [47].

However, most of the studies were assessed the attitude towards dying care and knowledge in palliative care for nurses rather than physicians and health care workers.

There is a need to introduce or reinforce the study of palliative care in the curriculum of medical doctors, nurses, pharmacists, and other healthcare workers both at undergraduate and postgraduate levels.

The improvement of attitudes towards palliative care is crucial to enable healthcare professionals who have a role in referring patients to palliative care, to discuss services in a positive way and facilitate a seamless transition to palliative care as well as reduce fear of death and a sense of failure when referring patients to palliative care [48, 49].

The attitude of professionals has been found to be one of the most significant predictors of quality of care which has a positive impact on quality of life at the end of patients' lives [50]. Negative attitudes create barriers to providing comprehensive patient care [51, 52].

This can cause stress and anxiety for professionals when caring for patients in endof-life situations, which can affect their own health in the long term [53, 54].

HCP has to know about that:


McLoughlin (2012) identified the attitude towards palliative care highlighted the need to educate the public on issues concerning palliative care. That was consisted with 2014 Nigeria study showing the gaps in the knowledge of healthcare workers in the area of palliative care [30].
