Syrian Health Providers' Knowledge of Palliative Care: An Online Cross‑Sectional Study in Syria

Background: Palliative care is a method to alleviate pain and enhance the quality of life for patients suffering from the consequences of a life-threatening illness. The knowledge of palliative care among healthcare professionals is poor; therefore, training programs are needed to offer patients appropriate treatment and improve their health. In Syria, as palliative care programs are rarely applied, we aim to evaluate the knowledge regarding palliative care among healthcare workers. 
  
Methods: This is an online cross-sectional study conducted between July 24 and August 28, 2022 to measure palliative care knowledge and its applications among Syrian healthcare workers. The questionnaire for the study was designed in light of a previous study, and the inclusion criteria were Syrian healthcare workers, including physicians and nurses, as well as medical and nursing students. The four sections of the questionnaire included sociodemographic information in the first part, while the second, third, and fourth parts assessed experience, knowledge, and attitude toward palliative care among healthcare workers, respectively. Data were analyzed in IBM SPSS V. 28.0 using descriptive and multivariate logistic regression analysis. 
  
Results: Among 602 participants, 66.2% of participants were females. Most respondents were medical students (72.9%), while residents and nurses or nursing students represented 18.8% and 8.3%, respectively. The majority of participants (84%) answered the question about pain treatment goals correctly, while a small percentage (5.3%) answered the question about whether or not long-term opioid use is addictive correctly. No significant difference in the overall knowledge score was shown among geographical areas, genders, and different specialties. Regarding the knowledge questions related to palliative care, only 14 participants were considered knowledgeable. The three most responses that received agreement regarding the attitudes towards palliative care were “Pain relievers should be given as needed to terminally ill patients” (89.7%), “Spiritual care must include counseling for the terminally ill patient” (84.3%), “Patients have the right to determine their own degree of psychosocial intervention” (81%).  A significant difference existed between urban and rural residents in terms of the attitude score. When comparing first-year students to those in their fifth year, students in their fifth year were 8.06 times more likely to have a positive attitude.     
  
Conclusions: Our results demonstrated that healthcare professionals have inadequate knowledge about palliative care. There is an urgent need to introduce palliative care to the health system in Syria in order to improve the quality of life of these patients in their terminal stages of illness and to provide care for patients who need it.