Differences in Physicians' Beliefs about the Care of Terminally Ill Patients in the U.S. and Hungary [Новость добавлена - 25.02.2008]

Csikos, Agnes; Mastrojohn, John and Albanese, Teresa

The collaboration between the Hospice –Palliative Program of Summa Health System, Akron Ohio and Pecs University, Medical School, Institute of Family Medicine dates back for almost ten years. One of the results of the collaboration was the visit of John Mastrojohn (who was the Director of Summa Hospice at that time) as a Fulbright fellow at our Institute in Pecs in 2004-2005. This was the year when we started to establish our hospice home care program. He was a great help not only in practical matters but also in designing and conducting a research together. As hospice care was a new introduction into the health care system in Hungary, we believed that it is fundamental to learn more about the primary care physicians' beliefs and perceived barriers regarding end-of-life care. To continue the started research program I applied for a Fulbright Scholarship and now I am a Fulbright Scholar at Summa Hospice in Akron. During the fall of 2007 we conducted a similar survey to the one done in Hungary earlier. Bellow is a short description of the cross-cultural survey. Research Aims:  This research aims to identify cross-cultural differences in physicians' knowledge of and perceived barriers to hospice services.  The survey also assessed their beliefs and attitudes about care and communication with terminally ill patients. We hypothesize that differences exist as a result of cultural differences and the length of time that hospice has been integrated into the health care systems. Methods: Primary care physicians from Baranya County in Hungary and from Summit County, Ohio, in the Unites States (U.S.) were surveyed. The questionnaires were mailed to 300 physicians in both Hungary and the U.S.; 182 were returned in Hungary and 145 in the U.S. Data were entered into an SPSS program. Descriptive, bi-variate, and qualitative analyses were conducted to compare the two samples. Results:  Only .5% of Hungarian and 72% of U.S. physicians reported that currently available services for the terminally ill were exceptionally good. Thirty-eight percent of Hungarian, and only 5% of U.S. physicians believed that discussing a terminal prognosis with the patient would foster a sense of hopelessness. Fewer Hungarian physicians (15%) as compared to U.S. physicians (75%) believed that it is the right of the patient to know they have a terminal illness and they always tell them. Fifty percent of Hungarian physicians responded that the decision to inform patients of their terminal illness is balanced by the physician's judgment of the patient's best interest, compared to 19% of U.S. physicians. Conclusions:  The results elucidate some of the cross-cultural differences in physicians' beliefs about care of terminally ill patients. The differences may also reflect the less availability of hospice service in Hungary. Hospice has been reimbursed under the Hungarian health system since 2004 as compared to the U.S. where it was first covered by Medicare in 1983. Understanding and addressing barriers to physician referrals to hospice may improve patients' access to those services. The detailed analysis of the survey and to publish the results is a part of my Fulbright project. My future hope is to continue this fruitful collaboration between the two institutions by means of further researches and educational programs. Dr. Ágnes.Csikós MD University of Pécs, Medical Faculty agnes.csikos@aok.pte.hu

The Palliative Care in Central and Eastern Europe and Former Soviet Union Countries Monthly Email Newsletter January 2008