BONN PALLIATIVE CARE KNOWLEDGE TEST VALIDITY FOR PRIMARY HEALTH CARE PROFESSIONALSABSTRACT
Objective: to perform the translation, back-translation, content validity through analyses of internal consistency, reliability, reproducibility, and suitability of the name of the Bonn Palliative Care Knowledge Test, which assesses healthcare professionals’ knowledge and self-efficacy on palliative care in the context of Primary healthcare in Brazil.
Method: translation, cross-cultural adaptation, and content validity were carried out, with the participation of eight expert judges, 50 target audience judges, and 149 healthcare professionals, in addition to analyses of internal consistency, reliability, and reproducibility. The study was conducted in Primary Health Care units in the city of São Paulo, Brazil, between February 2021 and October 2022, being answered remotely via internet and approved by the Research Ethics Committees of the institutions involved.
Results: the Bonn Palliative Care Knowledge Test translation and cross-cultural adaptation in the Brazilian context were adequate, presenting good content validity (CVI>0.83), medium internal consistency for the knowledge construct (Cronbach’s alpha=0.486) and excellent internal consistency for the self-efficacy construct (Cronbach’s alpha=0.852), in addition to good overall reliability (ICC>0.5), excellent reproducibility (p-value=0.046), and was named as Questionário de Conhecimento e Autoeficácia sobre Cuidados Paliativos (BPW-BR).
Conclusion: the instrument proved to be valid for use in knowledge and self-efficacy assessment about palliative care by Primary Health Care professionals and may help improve teaching about palliative care for this audience.
DESCRIPTORS:
Palliative Care; Instrument; Validation Studies; Primary Health Care; Health professional
RESUMO
Objetivo: realizar a tradução, retrotradução, validação de conteúdo por meio de análises de consistência interna, confiabilidade, reprodutibilidade e adequação do nome do instrumento Bonn palliative care knowledge test, que avalia conhecimento e autoeficácia de profissionais da saúde sobre cuidados paliativos, no contexto da atenção primária à saúde no Brasil.
Método: foram realizados os processos de tradução, adaptação transcultural e validade de conteúdo, com a participação de oito juízes especialistas, 50 juízes público-alvo e 149 profissionais da saúde, além de análises de consistência interna, confiabilidade e reprodutibilidade. O estudo foi realizado em unidades de atenção primária à saúde da cidade de São Paulo, Brasil, entre os meses de fevereiro de 2021 e outubro de 2022, sendo respondido de forma remota via internet e aprovado pelos comitês de ética das instituições envolvidas.
Resultados: a tradução e adaptação transcultural do instrumento Bonn palliative care knowledge test no contexto brasileiro foram adequadas, apresentou boa validade de conteúdo (IVC > 0,83), consistência interna mediana para o construto conhecimento (Alfa de Cronbach=0,486) e ótima para o construto autoeficácia (Alfa de Cronbach=0,852), boa confiabilidade geral (ICC > 0,5), ótima reprodutibilidade (p-valor=0,046) e recebeu o nome de Questionário de Conhecimento e Autoeficácia sobre Cuidados Paliativos (BPW - BR).
Conclusão: o instrumento se mostrou válido para utilização na avaliação de conhecimento e autoeficácia sobre cuidados paliativos, por parte de profissionais da saúde atuantes na atenção primária à saúde e poderá auxiliar no aprimoramento do ensino sobre cuidados paliativos para esse público.
DESCRITORES:
Cuidados Paliativos; Instrumento; Estudo de Validação; Atenção Primária à Saúde; Profissional da Saúde
RESUMEN
Objetivo: realizar la traducción, retrotraducción, validación de contenido mediante análisis de consistencia interna, confiabilidad, reproducibilidad y adecuación del nombre del instrumento Bonn Palliative Care Knowledge Test, que evalúa el conocimiento y la autoeficacia de los profesionales de la salud sobre los cuidados paliativos, en el contexto de la atención primaria de salud en Brasil.
Método: se realizaron los procesos de traducción, adaptación transcultural y validez de contenido, con la participación de ocho jueces expertos, 50 jueces de audiencia objetivo y 149 profesionales de la salud, además de análisis de consistencia interna, confiabilidad y reproducibilidad. El estudio se realizó en unidades de atención primaria de salud de la ciudad de São Paulo, Brasil, entre febrero de 2021 y octubre de 2022, siendo completado de forma remota vía internet y aprobado por los comités de ética de las instituciones involucradas.
Resultados: la traducción y adaptación transcultural del instrumento Bonn Palliative Care Knowledge Test en el contexto brasileño fueron adecuadas, presentando buena validez de contenido (CVI > 0,83), consistencia interna promedio para el constructo de conocimiento (alfa de Cronbach= 0,486) y excelente para el constructo de autoeficacia (alfa de Cronbach = 0,852), buena confiabilidad general (ICC > 0,5), excelente reproducibilidad (valor p = 0,046), y fue nombrado Questionário de Conhecimento e Autoeficácia sobre Cuidados Paliativos (BPW-BR).
Conclusión: el instrumento demostró ser válido para su uso en la evaluación del conocimiento y la autoeficacia sobre cuidados paliativos por parte de los profesionales de salud que actúan en la Atención Primaria de Salud y puede ayudar a mejorar la enseñanza sobre cuidados paliativos para este público.
DESCRIPTORES:
Cuidados Paliativos; Instrumento; Estudio de Validación; Atención Primaria de Salud; Profesional de la salud
INTRODUCTION
Among the various forms of healthcare, the need to implement and improve palliative care (PC) stands out, which is intended for people with chronic diseases or conditions that can cause intense suffering, whether physical, psychological, social, spiritual or with no prospects of a cure¹.
PC, despite being fundamental, is still not very widespread, especially in developing countries, such as Brazil, where specialized PC services are still scarce, as is the healthcare professionals’ knowledge on the subject².
Primary Health Care (PHC) is one of the key sectors for improving PC, especially because it is the gateway to the Health Care Network (RAS - Rede de Atenção à Saúde) for users and allows for earlier diagnoses. PHC enables multidisciplinary teamwork, greater proximity to family members and users, ongoing discussions about cases, and understanding of the geographic and social space in which users live3, which are fundamental elements for providing PC.
There are, however, some challenges to carrying out PC in PHC, such as inappropriate infrastructure, lack of planning with other RAS services, high professional turnover, work overload for the team and lack of professional preparedness on the subject3-4. Furthermore, the Brazilian research scenario on this topic is still scarce, as it is a recent area³, as well as the provision of this type of service, including for older adults, which is the public with the greatest demand for PC5.
Given the scenario, it is essential to obtain more information about these professionals’ knowledge and self-efficacy regarding PC, in order to guide and support training, enabling improvements in quality of care and, therefore, in quality of life of patients and their families. Continuing education and transformation of care to a more interdisciplinary model are still insufficient in PHC6, and therefore data are needed to prove the investment in these types of actions.
To date, the only instrument found that measures healthcare professionals’ knowledge and self-efficacy about PC, validated for Portuguese language, is the Bonn Palliative Care Knowledge Test (BPW), developed in Germany in 2011. Initially, the instrument was validated to assess nurses and physicians, linked to Nursing Homes, and sought to follow the World Health Organization (WHO) guidelines on the subject7.
BPW consists of 38 items, 23 of which are about knowledge about PC (pain, symptom control, general knowledge about the topic and attitudes about death and dying) and 15 items that assess self-efficacy in providing PC. Respondents must indicate, on a Likert scale with four alternatives, how true the statements contained in the questionnaire are7.
In Portuguese, BPW validity has already been carried out in Portugal, with nurses and nursing students8, and, in Brazil, with nurses who worked in PHC9. The adaptation of the instrument’s name to Portuguese in these studies was Questionário de Conhecimentos sobre Cuidados Paliativos (BPW)9.
The Brazilian validity process presented confirmed content validity in relation to the original version; however, it did not present validity of the knowledge and self-efficacy constructs9. One hypothesis for the result obtained is that the instrument translation occurred from English to Portuguese and not from the original language of the instrument, which is German, which may present a semantic bias in the constructs and in the description of each assessment item.
As it has already been validated for Portuguese and in the context of PHC, it was considered to improve psychometric analyses, including other health professional categories, in addition to physicians and nurses, since PC is conceptually multiprofessional care¹.
Therefore, this study aimed to carry out the translation, back-translation, content validity through analyses of internal consistency, reliability and reproducibility and adequacy of the name of BPW, which assesses healthcare professionals’ knowledge and self-efficacy about PC in the context of PHC in Brazil.
METHOD
BPW was validated through translation, back-translation, reliability and reproducibility analysis processes.
The study was carried out in accordance with the Guidelines and Regulatory Standards for Research Involving Human Beings (Resolutions 466/2012 and 510/2016 of the Brazilian National Health Council - Ministry of Health), and was approved by the Research Ethics Committees of the Universidade de São Paulo School of Arts, Sciences and Humanities and the Municipal Health Department of São Paulo.
Authorization was granted by the creators of the original instrument and by the Brazilian researchers who carried out the first validity and cross-cultural adaptation of BPW in Brazilian Portuguese.
Participants were previously informed about the procedures performed and instructed to sign the Informed Consent Form (ICF), which enables data collection for research and publication, and were given a copy of the document.
The first selection of participants was made up of expert judges, which is recommended to be made up of five to ten people responsible for the quantitative and qualitative assessment of the instrument in question10. Therefore, it needed to be made up of professionals with diverse backgrounds in the health area and who work in public and private services, with at least five years of training, graduate education in PC or related areas and experience in clinical practice with PC care.
In the stage of selecting the target audience judges, a number of at least 30 people is recommended, who have a similar profile to the audience to be assessed with the questionnaire11. In the case of this study, the profile consisted of being a healthcare professional, working in PHC, with higher education, availability to answer the questionnaire carefully and sign the ICF.
In the selection stage of participants answering the questionnaire, the target number was 380 people, since it is recommended, in assessments of reliability and reproducibility analysis of instruments, there must be at least ten respondents for each item assessed - in the case of BPW there are 3811. Healthcare professionals, with higher education and working in PHC in the southeast, north and east health regions of the city of São Paulo, SP, were included. Healthcare professionals unavailable to complete the survey due to vacation or leave and consultation of materials or other professionals while completing BPW questionnaire were excluded.
The process began with the translation of the original instrument in German into Brazilian Portuguese. This procedure was carried out by two translators whose native language is Portuguese, one of whom had knowledge of the subject addressed in the instrument (T1) and the other was a layman on the subject (T2)12.
After obtaining the two versions (T1 and T2), a synthesis was performed (T-12). Then, back-translation was performed, in which versions T1 and T2 were translated by two other translators, who have German as their native language, obtaining two other documents (BT1 and BT2). This process was important to highlight possible discrepancies that could exist in the instrument content in relation to semantic construction12.
After translation and back-translation were completed, a committee of expert judges was called, consisting of eight professionals with expertise in PC who assessed possible needs for word changes, sentence structure and question clarity according to the literature10,13. The expert judges received instructions from the researcher, in addition to online form containing explanations about the instrument and the analysis process that should be carried out. The form contained questions about professional and academic data and BPW questionnaire, with spaces for assessing the clarity of each instrument item, both quantitatively, by selecting alternatives from a Likert-type scale, and qualitatively, being able to write suggestions for changes to the questions that they believed to be pertinent13.
To find out what was the agreement among the eight expert judges about each item, the Content Validity Index (CVI) was calculated, and the cut-off value was 0.83, a value recommended for six to eight judges. Those items that obtained a CVI lower than this value need to undergo review or even be excluded10,13.
After assessment by expert judges, target audience judges’ opinion11-12, who were 50 healthcare professionals with a profile similar to the questionnaire respondents, was also requested. The target audience judges were asked to answer the pre-final version obtained after CVI analyses. They should report any type of difficulty in understanding. If 15% or more of the participants in this stage presented any difficulty, items would undergo a new review11-12.
Data collection was carried out with the participation of 149 PHC healthcare professionals with different backgrounds, but all with higher education degree. The data were obtained remotely, with assessment instruments being completed online using Google Forms.
For reproducibility analysis, 49 participants were recruited to answer BPW questionnaire 30 days after the first assessment. They were asked to report whether they had any type of contact with theoretical-practical content about PC in the interval between assessments.
Cronbach’s alpha was used to measure internal consistency. Values closer to 1, show better internal consistency. The Interclass Correlation Coefficient (ICC) was applied to measure instrument reliability, which indicates how much the items in each domain actually measure what they claim to measure, with values between 0 and 0.25 being considered poor, 0.25 to 0.50, regular, 0.50 to 0.75, good, and 0.75 to 1.00, excellent11.
Reproducibility analysis was performed, since its objective is to measure the stability of the instrument’s answers over time, expressing the instrument’s ability to produce the same or similar results, at different times, under the same circumstances. Therefore, the more similar are the values of the first and second moments, the better the reproducibility14-15. For this analysis, the Wilcoxon test was performed, aiming to verify the relationship between test and retest moments with p-value > 0.05.
RESULTS
Translation, back-translation and content validity
The first version of BPW emerged after translation and back-translation processes from German to Brazilian Portuguese, and was delivered to the panel of expert judges, composed of eight female judges, with professional training time between five and 26 years, working in public and private institutions, all with at least one pos-graduation degree in areas related to PC and had degrees in psychology, medicine, speech therapy, nursing, physiotherapy and gerontology.
Based on the answers given by expert judges, considering the clarity of each of the 38 items in the questionnaire, a CVI was applied. In the knowledge construct, items 2, 4, 9, 11 and 22 presented values below the cut-off score and, therefore, were modified according to judges’ suggestions. In the self-efficacy construct, all items obtained a CVI greater than 0.83, therefore they were maintained without changes.
Expert judges also helped to develop the template of the most appropriate answers for each of the 23 knowledge-related questions.
The final version of the instrument was renamed as Questionário de Conhecimento e Autoeficácia sobre Cuidados Paliativos (BPW-BR) (Chart 1). It was answered and analyzed by the target audience judges, resulting in an average answer time of 15 minutes and no significant difficulty in understanding any item of the questionnaire, with no further modifications being necessary.
Internal consistency, reliability and reproducibility analyses
For the analyses of internal consistency and reliability of BPW-BR, the significance level determined was 0.05 and non-parametric statistical tests were used, since the data did not present a normal distribution according to the Kolmogorov-Sminov test (N≥30).
For internal consistency analysis, Cronbach’s alpha test was performed, with moderate results for knowledge (0.486) and excellent for self-efficacy (0.852). For reliability analysis, ICC was performed for each of the 38 items of BPW-BR questionnaire (Table 1).
The closer the ICC value is to 1, the more reliability there is, and it can be seen that there was poor reliability for items 1, 5, 11, 15 and 19 of knowledge and in items 5, 7 and 15 of self-efficacy.
To verify the instrument reproducibility, the Wilcoxon test was applied to the data of the 49 participants who answered the reassessment. A statistically significant difference was found only in item 8 of knowledge (p-value = 0.046). This result indicates that the values obtained at the time of assessment were very similar to those found at the time of reassessment, showing that the instrument has good reproducibility and remained stable at different times, but under the same circumstances.
DISCUSSION
Knowing the need to expand teaching about PC in Brazil, especially in PHC, understanding healthcare professionals’ knowledge and self-efficacy who work in this context, is an important step to be taken2,4.
Validating BPW for Brazil so that it can be applied in PHC is essential, because it allows us to understand whether it is the ideal instrument for measuring healthcare professionals’ knowledge and self-efficacy who work in this context so that, through the results, it is possible to implement improvements in qualifications and training for these professionals.
In the German version, physicians and nurses who worked in Nursing Homes7 were assessed. In the Portuguese version, nurses and nursing students8 were assessed. In another Brazilian validity, only nurses who also worked in PHC9 were assessed. In this study, however, we assessed healthcare professionals from various professional categories working in PHC, including nurses, physicians, physiotherapists, speech therapists, occupational therapists, social workers and dentists. It was also decided that the name of the instrument would be Questionário de Conhecimento e Autoeficácia sobre Cuidados Paliativos (BPW-BR).
According to the results, translation, back-translation and cross-cultural adaptation into Brazilian Portuguese were carried out correctly, presenting the necessary criteria and following all the established steps12. The instrument also showed content validity in both knowledge and self-efficacy construct, since CVI was greater than 0.83 in almost all items, and those with lower values were adapted according to expert judges’ suggestions10,13.
The target audience judges did not show any difficulty in completing BPW-BR questionnaire, and the mean time taken to complete the questionnaire was close to the values of previous validities8-9. It is known that short application times, such as those obtained in the current version, can help to encourage participants to complete the questionnaire until the end, without harming participants’ work routine.
Although internal consistency was a median value for knowledge (0.486) and an excellent value for self-efficacy (0.852), these results are in line with those presented in the German and Brazilian versions, where more inconsistencies also emerged in the knowledge construct7,9. Thus, it can be inferred that the items on knowledge have more technical terms, more complex concepts and, therefore, greater difficulty in interpreting and constructing the construct.
In this approach, the international literature has shown that other questionnaires that measure knowledge about PC by healthcare professionals also found median values of internal consistency, such as the Palliative Care Knowledge Questionnaire-Basic (PCQK-B), with a value of 0.6516, the palliative care quiz for nursing (PCQN-SV), with a value of 0.6717, and the palliative care attitude and knowledge (PCAK), with a value of 0.6318. All, however, proved to be valid instruments for use in research by physicians and/or nurses, highlighting the importance of conducting new psychometric analyses.
When measuring reliability, poor values were found for items 1, 5, 11, 15 and 19 of the knowledge construct and for items 5, 7 and 15 of the self-efficacy construct.
In item 1 of the knowledge construct (“Palliative care should never be combined with curative treatments”), the statement is incorrect, since the fact of receiving PC does not cancel out the possibility of receiving curative treatments, since several people in PC end up surviving and even having their survival increased. This issue can be quite confusing due to people’s lack of understanding of the terms and the variety of different words that are used to refer to the same type of intervention19. In Brazil, the variety is great, and professionals show that they are not clear about each of them, using them indistinctly in clinical practice20.
For item 5 (“Complementary therapies are impprtant for pain control”), the statement is correct, since some time ago studies showed that therapies such as massage and acupuncture can be good strategies for managing pain in cancer patients21. Perhaps, the difficulty in understanding this issue may be related to the lack of clarity on the part of healthcare professionals about what complementary therapies would be, since, in Brazil, the most used term is Integrative and Complementary Practices (ICPs)22. In this regard, it is suggested to change this term in item 5.
Item 11 (“Fear and exhaustion decrease the intensity of pain”) is incorrect, since these sensations may not only be present simultaneously with pain, but may also enhance its effect23. One hypothesis for the lack of clarity in this statement would be the fact that fear is a feeling, exhaustion is a psychological or physical symptom, and pain is a physical sensation, mixing several sensory experiences into a single question, making it hard to give a clear answer without first reflecting more deeply on the statement.
The statement in item 15 (“Communication skills can be learned”) is correct and, in this case, it is essential that professionals are guided on the possibility of this type of learning, since communication is one of the most important pillars in the management of patients in PC and can be acquired adequately with specific techniques24. Even in the construction of specialized PC services, educational practices and communication incentives are considered fundamental to be considered places of excellence25.
In item 19 (“The use of antidepressants in pain therapy makes no sense”), the statement is incorrect, since the class of antidepressants is widely used as an adjuvant in pain treatment together with opioids, and plays an important role in cases of neuropathic pain26. As this is a question that involves more technical knowledge, which physicians and nurses are more accustomed to, it is considered that this item may have constituted a challenge for the other healthcare professionals who answered the questionnaire, highlighting one of the characteristics of BPW, which is precisely having more clinical questions that are not within the scope of some professionals in the multidisciplinary team.
For self-efficacy items, there is no parameter for how correct a statement is, since it concerns what a professional believes about themselves, being a more subjective perception. It is expected, however, that the answers affirm the veracity of items, representing that they feel capable of facing certain situations.
Interestingly, the three self-efficacy questions (5, 7, and 15) that presented poor reliability refer to communication skills and social management with patients and family members. Participants’ answers tended to be “rather correct” and “barely correct”, showing that professionals are insecure about communication. PC involves communicating bad news, welcoming, qualified listening, and constant interest in patients’ life. However, these are not well-developed skills throughout professionals’ training, including those who work in cancer centers who have great difficulty in this regard24.
Although some items presented poorer values after applying ICC, it can be considered that the instrument has guaranteed reliability and the difficulty in understanding can also be interpreted as a lack of knowledge about PC.
BPW-BR proved to be an instrument with excellent reproducibility and could be chosen as an alternative for pre- and post-training assessments related to PC carried out among professionals with a degree in the health area, since, under routine circumstances, the answers of participants in this research remained unchanged over the 30-day period. The only item that presented a significant difference was item 8 (“Palliative care requires constant emotional support”) of the knowledge construct, which concerns emotional aspects of care.
The limitations of this study include the lack of a gold standard instrument to compare with BPW-BR and the reduced number of participants who answered the questionnaire, which would ideally have been 380, but it was only possible to recruit 149. The limitation in the number of participants was due to respondents’ low availability, considering that the start of the collections coincided with a peak in the incidence of COVID-19 cases in 2021, generating overload on health teams and many absences due to contamination27. This study showed, however, the importance of psychometric improvements and the expansion of the number of participants and professional classes assessed.
CONCLUSION
BPW presented adequate translation and cross-cultural adaptation, good content validity, medium internal consistency for the knowledge construct and excellent internal consistency for the self-efficacy construct, in addition to good overall reliability and excellent reproducibility, proving to be a valid and adequate instrument for measuring knowledge and self-efficacy about PC by healthcare professionals with different backgrounds who work in PHC in Brazil. In the Brazilian version, it is now named Questionário de Conhecimento e Autoeficacia sobre Cuidados Paliativos (BPW-BR).
It is recommended that further studies be carried out to improve psychometric analyses, and it is suggested that assessments be expanded to include healthcare professionals working in other environments, in addition to increasing the number of participants, covering different Brazilian regions.
ACKNOWLEDGMENT
We would like to thank the professionals and managers of the PHC units in the Southeast, East and North health regions of the city of São Paulo who contributed to data collection and we would also like to thank the professionals with expertise in the subject who were expert judges in this study.
REFERENCES
-
1. World Health Organization. Palliative Care [Internet]. 2020 [cited 2023 Dec 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care
» https://www.who.int/news-room/fact-sheets/detail/palliative-care -
2. Rodrigues LF, Silva JFM, Cabrera M. Palliative care: Pathway in primary health care in Brazil. Cad Saude Publica [Internet]. 2022 [cited 2024 Jan 3];38(9). Available from: https://doi.org/10.1590/0102-311XEN130222
» https://doi.org/10.1590/0102-311XEN130222 -
3. Schulter T, Durand MK, Barros J, Arakawa-Belaunde AM, Macedo LC, Correa SM, et al. Potentialities and challenges for care in the primary health care context. Texto Contexto Enferm [Internet]. 2023 [cited 2024 Feb 20];32. Available from: https://doi.org/10.1590/1980-265X-TCE-2022-0333en
» https://doi.org/10.1590/1980-265X-TCE-2022-0333en -
4. Justino ET, Kasper M, Santos KS, Quaglio R de C, Fortuna CM. Palliative care in primary health care: Scoping review. Rev Lat Am Enfermagem [Internet]. 2020 [cited 2023 Nov 27];28. Available from: https://doi.org/10.1590/1518-8345.3858.3324
» https://doi.org/10.1590/1518-8345.3858.3324 -
5. Velloso ISC, Caram CS, Almeida IRP, Souza MJS, Silva MH, Galdino CS. Palliative Care for the Elderly in the Healthcare System: A Scoping Review. Aquichan [Internet]. 2022 [cited 2023 Dec 11];22(3):1-19. Available from: https://doi.org/10.5294/aqui.2022.22.3.8.
» https://doi.org/10.5294/aqui.2022.22.3.8. -
6. Schulter T, Juvinyà-Canal D, Durand MK, Reig-Garcia G, Corrêa SM, Martins L, et al. Health promotion practices in primary care: Comparison between Florianópolis-Brazil and Girona-Spain. Texto Contexto Enferm [Internet]. 2023 [cited 2024 Mar 25];32. Available from: https://doi.org/10.1590/1980-265X-TCE-2023-0075en
» https://doi.org/10.1590/1980-265X-TCE-2023-0075en -
7. Pfister D, Müller M, Müller S, Kern M, Rolke R, Radbruch L. Validierung des Bonner Palliativwissenstests (BPW). Schmerz [Internet]. 2011 [cited 2024 Jan 12];25(6):643-53. Available from: https://doi.org/ 10.1007/s00482-011-1111-7
» https://doi.org/ 10.1007/s00482-011-1111-7 -
8. Minosso J, Martins M, Oliveira M. Cross-cultural adaptation of the Bonn Palliative Care Knowledge Test: An instrument to assess knowledge and self-efficacy. Rev Enferm Ref [Internet]. 2017 [cited 2023 Oct 19];IVSérie(13):31-42. Available from: https://doi.org/10.12707/RIV16076
» https://doi.org/10.12707/RIV16076 -
9. Spinelli V. Conhecimento e autoeficácia em cuidados paliativos dos enfermeiros da Atenção Primária à Saúde [tese]. São Paulo, SP(BR): Universidade de São Paulo; 2019 [cited 2023 Dec 02]. Available from: https://doi.org/10.11606/T.7.2020.tde-11122019-165525
» https://doi.org/10.11606/T.7.2020.tde-11122019-165525 -
10. Yusoff MSB. ABC of Content Validation and Content Validity Index Calculation. Educ Med J [Internet]. 2019 Jun 28 [cited 2024 Feb 10];11(2):49-54. Available from: https://doi.org/ 10.21315/eimj2019.11.2.6.
» https://doi.org/ 10.21315/eimj2019.11.2.6. - 11. Hair JF, Sant’anna AS, Gouvêa MA. Análise multivariada de dados. 6th ed. Porto Alegre: Bookman; 2009.
-
12. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of cross-cultural Adaptation of self-report Measures. Spine [Internet]. 2000 [cited 2023 Nov 30];25(24):3186-91. Available from: https://doi.org/10.1097/00007632-200012150-00014
» https://doi.org/10.1097/00007632-200012150-00014 -
13. Alexandre NMC, Coluci MZO. Content validity in the development and adaptation processes of measurement instruments. Cien Saude Colet [Internet]. 2011 [cited 2023 Oct 17];16(7):3061-8. Available from: https://doi.org/ 10.1590/s1413-81232011000800006
» https://doi.org/ 10.1590/s1413-81232011000800006 -
14. Farias Júnior JC, Lopes AS, Mota J, Santos MP, Ribeiro JC, Hallal PC. Validity and reproducibility of a physical activity questionnaire for adolescents: Adapting the Self-Administered Physical Activity Checklist. Rev Bras Epidemiol [Internet]. 2012 [cited 2023 Nov 5];15(1):198-210. Available from: https://doi.org/10.1590/S1415-790X2012000100018
» https://doi.org/10.1590/S1415-790X2012000100018 -
15. Souza AC, Alexandre NMC, Guirardello EB. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol Serv Saude [Internet]. 2017 [cited 2023 Dec 22];26(3):649-59. Available from: https://doi.org/10.5123/s1679-49742017000300022
» https://doi.org/10.5123/s1679-49742017000300022 -
16. Pruthi M, Bhatnagar S, Indrayan A, Chanana G. The Palliative Care Knowledge Questionnaire-Basic (PCKQ-B): Development and Validation of a Tool to Measure Knowledge of Health Professionals about Palliative Care in India. Indian J Palliat Care [Internet]. 2022 [cited 2024 Mar 15];28(2):180-191. Available from: https://doi.org/10.25259/IJPC_80_2021
» https://doi.org/10.25259/IJPC_80_2021 -
17. Chover-Sierra E, Martínez-Sabater A, Lapeña-Moñux Y. Knowledge in palliative care of nursing professionals at a Spanish hospital. Rev Lat Am Enfermagem [Internet]. 2017 [cited 2023 Nov 18];25:e2847. Available from: https://doi.org/10.1590/1518-8345.1610.2847
» https://doi.org/10.1590/1518-8345.1610.2847 -
18. Al-Ansari AM, Suroor SN, AboSerea SM, Abd-El-Gawad WM. Development of palliative care attitude and knowledge (PCAK) questionnaire for physicians in Kuwait. BMC Palliat Care [Internet]. 2019 [cited 2024 Jan 10];18(1):49. Available from: https://doi.org/10.1186/s12904-019-0430-9
» https://doi.org/10.1186/s12904-019-0430-9 -
19. Gaertner J, Knies A, Nauck F, Voltz R, Becker G, Alt-Epping B. “Curative” treatments and palliative care: The lack of consensus. Curr Opin Oncol [Internet]. 2014 [cited 2024 Jan 25];26(4):380-4. Available from: https://doi.org/10.1097/CCO.0000000000000099
» https://doi.org/10.1097/CCO.0000000000000099 -
20. Moscoso CR, Cordeiro FR, Gomes MP, Oliveira SG, Graciela J. Assistance practices of medical and nursing teams for hospitalized people in palliative care. Texto Contexto Enferm [Internet]. 2023 [cited 2024 Apr 14];32:e20230080. Available from: https://doi.org/10.1590/1980-265X-TCE-2023-0080en
» https://doi.org/10.1590/1980-265X-TCE-2023-0080en -
21. Lopes- Júnior LC, Rosa GS, Pessanha RM, Schuab SIPC, Nunes KZ, Amorim MHC, et al. Efficacy of the complementary therapies in the management of cancer pain in palliative care: A systematic review. Rev Lat Am Enfermagem [Internet]. 2020 [cited 2023 Nov 7];28:e3377. Available from: https://doi.org/10.1590/1518-8345.4213.3377
» https://doi.org/10.1590/1518-8345.4213.3377 -
22. Ministério da Saúde. Política Nacional de Plantas Medicinais e Fitoterápicos [Internet]. 2006 [cited 2023 Nov 13]. Available from: https://www.gov.br/saude/pt-br/composicao/sectics/plantas-medicinais-e-fitoterapicos/ppnpmf
» https://www.gov.br/saude/pt-br/composicao/sectics/plantas-medicinais-e-fitoterapicos/ppnpmf -
23. Renz M, Reichmuth O, Bueche D, Traichel B, Mao MS, Cerny T, et al. Fear, Pain, Denial, and Spiritual Experiences in Dying Processes. Am J Hosp Palliat Med [Internet]. 2017 [cited 2023 Dec 29];35(3):478-91. Available from: https://doi.org/ 10.1177/1049909117725271
» https://doi.org/ 10.1177/1049909117725271 -
24. Bastos BR, Galvão da Fonseca AC, Da Silva Pereira AK, De Souza e Silva LC Health Care Professionals’ Training in Communicating Bad News in Oncologic Palliative Care. Rev Bras Cancerol [Internet]. 2016 [cited 2024 Feb 3];62(3):263-6. Available from: https://doi.org/10.32635/2176-9745.RBC.2016v62n3.327
» https://doi.org/10.32635/2176-9745.RBC.2016v62n3.327 -
25. Paiva CF, Silva CPG, Santos TCF, Augusto PS, Ennes LD, Almeida Filho AJ de. Oncology nursing and palliative care in a reference institution (2005 - 2006). Texto Contexto Enferm [Internet]. 2023 [cited 2024 Apr 4];32:e20230106. Available from: https://doi.org/10.1590/1980-265X-TCE-2023-0106en
» https://doi.org/10.1590/1980-265X-TCE-2023-0106en -
26. Scarborough BM, Smith CB. Optimal Pain Management for Patients with Cancer in the Modern Era. CA Cancer J Clin [Internet]. 2018 [cited 2023 Dec 21];68(3):182-96. Available from: https://doi.org/10.3322/caac.21453
» https://doi.org/10.3322/caac.21453 -
27. Ministério da Saúde. Covid-19 Casos e Óbitos [Internet]. 2020 [cited 2023 Nov 13]. Available from: https://infoms.saude.gov.br/extensions/covid-19_html/covid-19_html.html
» https://infoms.saude.gov.br/extensions/covid-19_html/covid-19_html.html
NOTES
-
ORIGIN OF THE ARTICLE
Article extracted from the dissertation -“Possibilidades de mensurar o conhecimento e a autoeficácia sobre cuidados paliativos de equipes multiprofissionais atuantes na atenção primária à saúde”, submitted to the Graduate Program in Gerontology at the School of Arts, Sciences and Humanities, Universidade de São Paulo, in 2023.
-
APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Ethics Committee in Research of the Municipal Health Department of São Paulo, under Substantiated Opinion 5,096,355, issued on November 10, 2021, and of the School of Arts, Sciences and Humanities, Universidade de São Paulo, under Opinion 5,638,487.
-
TRANSLATED B
Y Letícia Belasco.
