ABSTRACT-Palliative care aims at alleviation of physical symptoms with relieving psychological, social, and spiritual distresses in patients with severe or life-threatening illness. In Bangladesh palliative care is not significantly implemented yet. According to 2015’s Quality of Death Index by the Economist Intelligence Unit (EIU) Bangladesh held the position of 79 out of 80 nations providing palliative care. There are only few medical institutions providing this care and also building advanced curriculum on palliative care. However, there is no curriculum on palliative care in non-medical life science departments in this country. Thus the people who are educated are not even aware of this care. Therefore, the main objective of this study is to assess the knowledge level of the students with importance of including curriculum of palliative care among the non-medical life disciplines students of Bangladesh. The present study is an online cross sectional survey, where 307 respondents from non medical life science discipline were participated. According to the study 58% of the respondents believe terminal patients are not having proper care in Bangladesh and 78% of the respondents mention that palliative care should be added as a course material in life science discipline. Thus to have a clear knowledge on palliative care is very necessary to involve in the academic curriculum as a course in non medical life science disciplines.

Key-words- - Palliative Care, Education, Non Medical Life science, Bangladesh

INTRODUCTION- Palliative care is the way to improve the quality of life of patient and their families in life threatening diseases like cancer, stroke or other terminal illness and give relief from symptoms, pain and stress ^[1]. The ultimate goal of palliative care is to ensure the quality of lives of the patients and to fulfill the needs of patients’ families ^[2]. Knowledge of palliative care is very important for the health care providers. Normally medical providers are trained to investigate and diagnose of diseases of the patients which are followed by treatments. But palliative care providers ensure improved quality of life (QoL) of the patients by controlling the symptoms and alleviating the physical, mental, social and spiritual pain ^[3].
The World Health Organization (WHO) emphasizes on the importance of palliative care in developing countries as the patients in of these countries visit the medical treatment providers only when they are in serious stages of illness. WHO recommended home based palliative care services to those countries whose have less resource of palliative care facilities^[2]. Globally there are some misconceptions on palliative care. This misconception is usually found more in developing countries because the patients and health care professionals’ in developing countries have less oppor-tunity to get such knowledge and education. The people in developing countries can’t differentiate between palliative care and hospice or end life care. Palliative care is far different from the hospice care because it assures prevention and relieving patients from pains due to seriously patients including terminal illness. But hospice care set up is needed when the patient is incurable and at the end of life stage. Another misconception about the palliative care is that the people think it as an approach which is similar to disease-direct treatment. However, disease direct treatment and palliative care should continue simultaneously for seriously ill patients ^[4]
A very important part of palliative care is to manage the pain of the patients. It was found from other studies that people suffering from chronic pain have four times more suffering from depression or anxiety ^[5]. WHO has recommended medications depending on the severity of pain ^[6]. Globally, about 80 percent of the population lives in such countries where either they have less access to palliative care or have no opportunity of this care. A significant number of patients suffer from pain mismanagement, especially in underdeveloped or developing countries. Palliative care givers mainly attempted to make sure the availability of palliative care in the country by increasing awareness, training of care givers, developing the guidelines for palliative care including improvement of clinical and other health focused rights^[2].
Developed countries, like USA, Canada, Australia and UK have more positive history of palliative care ^[7]. The very notable history of Canada is that they started palliative care curriculum in medical studies since 1993. Australia also organized undergraduate curriculum and research opportunity on palliative care practice ^[4]. Recently universities of different countries have included palliative care study in academic curriculum. University of California of San Diego, Scripps Green, Scripps Mercy and Balboa Naval have included palliative care study in residency program under the internal medicine department, where others like Camp Pendleton and Scripps Chula Vista have enrolled palliative care study in Family Medicine as academic courses. These institutions assigned curriculum hours from 32 to 144 ^[8]. In India the approval of medical specialization on palliative care is one of the notable ones. In 2011 the Medical Council of India had approved the curriculum on palliative care ^[2]. Council of Europe emphasized palliative care for the elderly to promote the human right of these populations ^[9].
The options and opportunities of palliative care are not available in Bangladesh. “Centre for Palliative Care” in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh is one of the leading palliative care providers in ^[10]. This centre has been established on 2007.Although there are other organizations to provide palliative care but they do not have the significant functions. This may be due to the lack of knowledge of the people in Bangladesh. Although in medical science Palliative care topics are studied by the students, however, these practices are not included in other life science curriculums so far. Therefore, it is necessary to have such course in our academic curriculum in Life Sciences disciplines. Including the course in the curriculum in Life Science Department will help the non-medical health care professionals, general people and patients to know about this care properly which ultimately benefit the patients suffer from the severe and terminal diseases. So far no study has been carried out to examine the knowledge pattern regarding the Palliative Care in Bangladesh. Therefore, we conducted this study to examine the minimal knowledge of Palliative Care in students of non-medical life science discipline.

MATERIALS AND METHODS
Study Population- This study was conducted on the students of different public and private universities in Dhaka, Bangladesh. This is an anonymous, web-based study sent to 500 participants among those 344 participants responded. From the responded population accepted sample was 307 and remaining 37 data was rejected due to their aberrant responses. Among the accepted participants the ratio of male and female was 1:1.2 (Male 139 and Female 168). The age range was in between 18 to 30, where students from undergrad and masters participated. All of the students were from life science discipline except medical students like pharmacy, Genetics engineering, Biotechnology, Biochemistry and Public health.

Study Duration- Data collection was performed in 2016 from June 21st to September 21stin the total 3 months the online form was available 24 hours in a day to submit the response of participants. After collection of data, it was recorded in data store.

Study Type- The study was a cross sectional study where people responded within the given 3 months, and both the open end and close end questions were in the question form.

Study Tool Questionnaire- The research team developed a self-administered web-based questionnaire, where 20 questions were designed among those 17 questions was directly related to palliative care knowledge and population was asked to give their opinion on palliative care knowledge through these questions. Other 3 questions was the basic information of population age, gender and discipline. In questionnaires there were both the open ended and close ended questions.

Questions Development- In the study it was critically evaluated both the theo-retical and methodological issues associated with questionnaire design and development and different journal papers relevant with this study were studied to develop the questioners.

Statistical Analysis-The statistical analysis was done by Microsoft Excel 2007 and presented by Table.

Results: This survey was conducted on 307 students from non medical life science discipline. There were 139 male and 148 female participated in the survey. The responses of the primary questions by the respondents are shown in the Table 1.

Table 1: Responses of the participants on different questions regarding palliative care

Question.	Yes (%)	No (%)	Not Sure (%)
Familiarity with the word Palliative Care	75.21	24.79	-
Feel comfortable when talking on death	63.19	18.25	18.56
Terminal patients are not having proper care in Bangladesh societies	57.60	25.40	7.26
Palliative Care is reducing the pain of Patient	68.07	9.5	22.43
Hospital setting is compulsory to get Palliative Care	48.20	51.79	-
Palliative Care should be added as course material in life science discipline	78	18.24	4.20

In Table 1 above illustrates 78% of the respondents mention that palliative care should be added as a course material in life science discipline. According to the study 58% of the respondents believe terminal patients are not having proper care in Bangladesh society.
Table 2 showsthe reply from the respondents (n=307) regarding the recipients of Palliative Care. About 60% respondents reply that only the cencer patients should be the recipients of palliative care. About 10% of the respondents think that any patients during their illness can receive the care. Only 15% and 20% respondents select the recipients of palliative care as terminally ill patients and elderly patients respectively.

Table 2: Reply from the respondents (n=307) regard-ing the recipients of Palliative Care

	Any Patient	Termina Patient	Cancer Patient	Aged Population
Recipients of Palliative Care	8.5	12	59.5	20

Table 3 shows the main barriers for building the development of awareness of palliaitve care. With given three main obltacles of building the palliative care awareness, 56% respondents reply that the people donot have the proper idea of the palliative care. About 17% select the lack of institutional efforts is the barrier in improving the awareness of palliative care.

Table: 3 Reply from the respondents (n=307) re-garding the main barriers in improving the awareness of Palliative Care

	Poor Infrastructure to know Palliative Care	Lack of Proper Idea	Lack of Institutional effort
Main barriers in improving the awareness of Palliative Care	27.03%	56.35%	16.62%

DISCUSSION- In this study we were found that about one fourth of the population is not so familiar with the term Palliative care and more than half of the population is agreed that terminally ill patients don’t receive proper care in the society of Bangladesh. In the case of both terminal and incurable diseases the reduction of pain, other symptoms, psychological and emotional elements are very important where palliative care can play a crucial role. In this survey about 68% respondents answered that palliative care can reduce the pain; 75% responded that they are aware about the palliative care. However, 60% respondents mentioned that the cancer patients are only the receiver of palliative care. These respondents even do not know that the Palliative care can be provided for the patients suffering from any severe including incurable diseases. It reflects that majority of respondents have the mis-concept about the palliative care as the end life care. Majority of the participants (56.35%) in this survey mentioned that lack of proper knowledge is the main barrier of improving the awareness of palliative care in patients who suffer from incurable diseases. This study shows that 78% of participants expect that palliative care study should be included as a course in the life science departments.

CONCLUSION- Bangladesh is one of the most densely populated developing countries in the world. Here, one of the major concerns of health sector is to prevent or treat the disease. But the question arises, when the disease is not curable and the terminally ill patients cannot be given comfort by providing palliative care. These patients suffer often because of the unavailability of this care. As a result the quality of life of the patient and the family members are affected at any point of the illness of the patient. In addition to control the pain and other symptoms, psychological and emotional needs are very essential elements for these patients. There are limited understanding of the people in this country about this palliative care. This is now the time for Bangladesh to focus on palliative care for terminally ill patients in parallel with other care. It can only be achieved to educate people by providing the knowledge related to this subject matter. Through this study it has been confirmed that Palliative Care topic should be added as a course material in life science discipline.

REFERENCES

1. World Health Organization. (2016). WHO, WHO Definition of Palliative Care. Available at: http://www.who.int/cancer/palliative/definition/en.
2. Lohman, D. and Amon, J. Evaluating a Human Rights-Based Advocacy Approach to Expanding Access to Pain Medicines and Palliative Care: Global Advocacy and Case Studies from India, Kenya, and Ukraine. Health & Human Rights: An International Journal, (2015); 17(2):149-157.
3. Wiener, L., Shaw Weaver, M., Sansom Daly, U. and Bell, C. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. Clinical Oncology in Adolescents and Young Adults, 2015; 5(1):1-3.
4. Horowitz, R., Gramling, R. and Quill, T. Palliative care education in US medical schools. Medical Education, (2013); 48(1):59-66.
5. Gureje, O., Von Korff, M., Simon, G.E. and Gater, R. Persistent pain and well-being: a World Health Organization study in primary care. The Journal of the American Medical Association, 1998; 280(2):147-151.
6. O'Neill, J.F., Selvyn, P.A. and Schietinger, H. A Clinical Guide to Supportive & Palliative Care for HIV/AIDS. US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, 2003; pp. 527-529.
7. MacDonald, N., Mount, B., Boston, W. and Scott, J.F. The Canadian palliative care undergraduate curriculum. Journal of Cancer Education, 1993; 8(3):197-201.
8. F. Gunten, C., Mullan, P., Nelesen, R., Garman, K., McNeal, H., Savoia, M., Muchmore, E., Ikeda, T., Amundson, S., McKennett, M., Diamant, J., Pepper, P., Gray, C. and Weissman, D. Primary Care Residents Improve Knowledge, Skills, Attitudes, and Practice After a Clinical Curriculum With a Hospice. American Journal of Hospice and Palliative Medicine, 2016;1(8):2-3.
9. Starmer, D., Jamrozik, K., Barton, M. and Miles, S. Evaluating curriculum changes in undergraduate cancer education. Journal of Cancer Education, 2013; 19(3): 156-160.
10. Hospicecare.com. (2016). Global Directory of Palliative Care Services, Hospices and Organizations. Available at: http://hospicecare.com/global-directory-of-providers-organizations/search/?idregion=4.
    
    

    How to cite this article: Pavel OF, Ahmad N, Islam S: Assessing the Knowledge Pattern Regarding the Palliative Care among the Non-Medical Life Students in Science Bangladesh. Int. J. Life. Sci. Scienti. Res., 2017; 3(4):1110-1113. DOI:10.21276/ijlssr.2017.3.4.1 Source of Financial Support: Nil, Conflict of interest: Nil