**3.3 Health care team's attitude towards palliative care**

Palliative care is a multi-discipline care system that tries to improve the quality of the patient and relieve them by controlling the symptoms related to the disease [55–57]. Pain and symptom management are the primary focus and psycho-social, spiritual and bereavement support are also provided by multi-discipline teamwork [5]. The basic palliative care teams are made up of physicians and nurses with the support of psychologists and social workers [58]. Additionally include other specialist, nutritionist, pharmacist, chaplain, physiotherapist (as shown in **Figure 3**).

Multi-discipline team provides the patients and their family members with physical, social, and emotional functional support based on the adequate knowledge of PC and favorable attitude towards the end-of-life care.

Positive attitudes towards palliative care are important to enable good communication between primary caregivers and specialist palliative care providers [59].

**Figure 3.** *Ministry of Health USA uploaded by 2011.*

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

In Mongolia, they concluded attitude towards inter-professional education in health care professionals needed more practice training for team efficacy and attitude value [60]. Training in palliative care and previous experience related to the end of life has an influence on improving the attitude of health professionals towards the care of patient's end of life [61].

Health care providers require a good relationship with dying patients and their family members. This is the most difficult process and forming such a relationship is painful as it involves suffering and grieving if the patient passes.

Good communication between all the health care professionals involved in a patient's care is essential and is fundamental to many aspects of palliative care and good communication with patients and families is also essential [32]. Good palliative care helps open up discussion with patients and their families about important aspects of end-of-life care [62]. Healthcare professionals should consider encourage cancer patients of such positive beliefs and though [63].

#### **3.4 Nurses attitude towards palliative care**

The palliative care nurses are expected to participant in the multidiscipline team coordinating for patients, but they need structured preparation to feel knowledgeable and comfortable so they can engage in conversations related to palliative care [41]. In 2022 Ethiopian researchers made Conceptual framework on factors associated with nurses' attitude towards nursing profession. Four different factors affecting nurses' attitude towards professional that are socio-demographic factors, organizational related factors, social supporting factors and health professional related factors [64]. Standards of oncology nursing education highlight the need to represent the scope of teaching in all phases of cancer care, including prevention, early detection, rehabilitation, survivorship, and supportive care [41].

Many studies reported a significant correlation between the level of knowledge and attitudes towards palliative care. This is highlighted that as a participants' level of knowledge increased, attitude became more positive either setting in hospitals such as in Lebanon India, Ethiopia, and Saudi Arabia primary care settings such as in Thailand. It is a part of human nature that the degree and complexity of knowledge affect their attitudes and in turn their behavior.

Nurses as well as other health care workers often feel unprepared for their tasks in palliative care and are in much need of more expertise in the field of pain and symptom management, communication, and dealing with ethical dilemmas [65].

Nurses are another key group with widely differing attitudes towards palliative care [55]. Nurses working in older people's care settings such as community hospitals and nursing homes are ideally placed to deliver palliative care [18].

The attitudes of nurses, who are frequently confronted with the phenomenon of death during the day, towards providing services to patients whose death is approaching are important for the quality of the care provided. The attitudes of nurses towards dying patients may vary based on their cultural structure, religious thought, social environment, family structure, the technology used in their unit, communication methods, palliative care training, and previous experience of encountering death [13, 55].

Nurses play an important role in the end-of-life care in attitudes of practices because they are more in direct contact with dying patients and spend more time with patients and their family members than other health care professionals. Additionally, nurse providers nursing problem such as pain, breathing difficulties, nausea, vomiting, and fatigue occurring in when patients need essential clinical care [55].

In1991 Degner et al. [1] determined nursing behavior in care for dying people is responding during the death scene, providing comfort, responding to anger, enhancing personal growth, responding to colleagues, enhancing quality of life during dying, and responding to the family.

#### **3.5 Undergraduate student attitude towards palliative care**

Palliative care (PC) education for medical students is very important. Because studies on medical students found that it is stressful dealing with end-of-life patients and coping when discussing bad news and encountering relatives' grief and fear of death. In recent years, medical school faculty have focused on disseminating misconceptions and fears as well as developing positive attitudes towards students' future role in providing PC [66, 67]. Although generally linked to education level and clinical learning, student attitude towards EOL care seem to have a wider range of influences, particularly cultural [68].

Medical students who experienced a patient's death during practice reported significantly more positive attitudes and clinical experience with EOL care was a significant predictor of attitudes in some of the studies taken in Mongolia (2021), Italy (2021), and Indonesia (2020).

Bassah et al. [69] concluded in their review on end-of-life attitudes in nursing students that little time is usually devoted to palliative care education or that it is often included in order specialized nursing courses [9]. The education on end-of-life (EOL) care as a portion of PC is very important for physicians, nurses and health care professionals should be prepared to provide quality EOL care [70]. Furthermore, medical education should prepare future students to meet increased PC about awareness and attitudes needs [71]. Medical education on PC in Asian countries could be improved by students' education from the European Association for Palliative Care or the End-of-Life Nursing Education Consortium.

Moreover, nursing educators could improve their capacity to teach PC courses by attending train-the-trainer sessions and nursing schools could change their curricula to include mandatory PC courses or integrate basic PC education into their curricula. However, teaching strategies may be important in improving the quality of PC education [10].

## **4. Public attitude towards cancer**

#### **4.1 Public impact of attitudes and feelings on cancer**

In spite of improving cancer survival rate, decreasing negative attitudes and myths about cancer [72] the thought of impending death [73, 74], social difficulties, and feeling isolated [63] are still around. Cancer survivors need prime support from people close to them to successfully cope with their diagnosis and treatment as well as continual support to improve their quality of life after treatment [75]. Additionally, government and non-government organizations should act to provide a more supportive environment [63, 72], and promote community awareness and intervention activities to enable access to community, social, and individual units for the social reintegration of cancer survivors [76]. In Korean studies from 2012 about public attitudes towards cancer such as cancer stigma, cancer disparities, and stereotypes of cancer. Looking at results of public attitude 58.5% think it is impossible to treat cancer

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

regardless of advanced technology, 71.8% think people with cancer are unable to make contributions to society, and 23.5% of people would avoid working with persons who have cancer [72]. Furthermore in Oman's public study 63% said they faced difficulties in marriage.

In 2007–2011, LIVESTRONG implemented a global cancer research study planned to give people who had a cancer a chance to share their cancer experiences and their view on the cancer problem that is caused by stigma and silence. They analyzed media coverage, public opinion surveys, and semi-structured interviews from Argentina, Brazil, China, France, India, Italy, Japan, Mexico, Russia, and South Africa [77]. Looking at the results, there has to be a positive change for cancer stigma, to improve cancer awareness, promote communication between cancer patients to share cancer experiences, and the education system including cancer awareness such as cancer prevention, early detection, tobacco use, nutrition [77]. Subsidiary also has to have positive change for disparities of cancer and cancer stereotypes [73].

Kathryn conducted a qualitative study on public perception of cancer, a balance of positive and negative beliefs, and concluded that; People appear to be "in two minds" about cancer. A rapid, intuitive sense of dread and imminent death coexist with a deliberative, rational recognition that cancer can be a manageable, or even curable, disease. Recognizing cancer's public image could help in the design of effective cancer control messages [74].

Negative attitudes formed from lifestyle and cultural factors, lack of education, religion, living in rural areas, smokers [75], low monthly income [76], misinformation about cancer screening, lack of health-seeking behaviors [73] and lack of rehabilitation during and after treatment. Patients with a negative attitude about cancer are affected by their quality of life, recovery from cancer, time of treatment, and adequate support from the workplace and society.

Discriminatory behavior towards cancer may isolate patients from their community, complicate returning to work after treatment, and have unfavorable physical and mental health consequences for cancer survivors [73]. Public education should also be focused on myths about cancer, such as the impossibility of recovery, and fear of the disease. In addition, people living with cancer should be encouraged to share their experiences with other people in society [73].

Morse Life Hospice studied people's beliefs and attitudes towards end-of-life care. The top three of awareness included huge support of medical marijuana, opinions on religion, and overall understanding of hospice care. The results show what the public wants and help identifies opportunities to increase awareness in the greater community. The study found that 87% of Americans support the use of medical marijuana as a treatment and believe it is important to have access to a religious leader of their faith for spiritual guidance during their hospice care (72%) [78]. An increasing number of cancer prevention campaigns supported by wellestablished theories about healthy behaviors have improved public health communication, leading to increased public awareness about the lifestyle risk factors related to cancer.

A positive attitude has also been linked to strong spirituality, religious beliefs, and a keen interest in cancer.

How to improve public role in supporting cancer patients. (What information do they need to know)

1.Understanding your diagnoses (what is cancer, how cancer is diagnosed, how to advance, how to cope, how do I talk to people about having cancer, etc.)

