Determining the Perceived Relative Importance of Physician Roles in Palliative Care through Best-Worst Scaling

Abstract

Introduction: A wide of range of physician roles in palliative care have been recognized by doctors in many countries. However, while the demand for palliative care keeps increasing in Singapore, there is a lack of understanding of Singaporean physicians' perceptions on their roles in palliative care. Assessment on the perceived relative importance of these physician roles is also needed for a thorough understanding of physicians' views on palliative care.Method: Nine physician roles were evaluated through twelve best-worst tasks. The worst counts were subtracted from best counts to develop a B-W score for each physician role. Paired model and marginal model were adopted to obtain an estimation of the coefficient of each role through conditional logit regression. Covariate-adjusted latent class cluster analysis was performed to investigate the heterogeneity among physicians and explore what physician characteristics are associated differences in perception patterns.Results: "Treating pain and physical symptoms" (1), "discussing end-of-life care preferences with patients" (2) rank top two, while "extending the patient's life as long as possible (8) and "withholding diagnosis if asked by family members" (9) are at the bottom regarding their perceived relative importance by respondents. The largest discrepancies regarding physicians' perceptions lie in "addressing patients' psychological needs", "addressing patients' spiritual needs" and "extending life as long as possible." Clinical grade and palliative care training status are found to have statistically significant association (P<0.05) with different patterns of perceptions among physicians.Conclusion: Singaporean physicians attach high importance to treating pains and symptoms, and value communicating with patients about treatment preferences based on effective information exchange. Respondents generally tend to focus more on patients' overall quality of life than just extending patients' life. Experience (reflected by clinical grade) and palliative care training may influence physicians' perceptions on their roles in palliative care.