The Development of Palliative Care Education and Training for General Practitioners in Yangon, Myanmar: a workshop success

Problem

Palliative care is an important but often overlooked component of primary care. It is a rapidly developing specialty yet, one third of the world still lack any community palliative care services, and suffer serious health suffering, particularly at the end-of-life, as a result. In Myanmar, the early emergence of palliative care is occurring with the first Palliative Care outpatient department opening two years ago, however, no formal community-based services yet exist. Present challenges include, cultural taboos, resource scarcity, restrictions around opioid prescribing and inadequate education and training.

The goal of this quality improvement work was to improve understanding and approach towards palliative care by General Practitioners (GPs) in Yangon.

Approach

An initial primary survey was performed amongst 42 GPs across three different locations (Yangon, Mandalay and Meiktila) in March 2019 demonstrating a gap in current training needs and confirming a willingness by GPs for this to be improved. A two-day workshop, the first ever of its kind, was subsequently designed and held in May for twenty local GP’s consisting of lectures and interactive sessions delivered in Burmese. Topics for the workshop included; what is palliative care?, recognising palliative symptoms, management of pain, management of common end-of-life care symptoms, breaking bad news and psychosocial and spiritual support.

Findings

Improvement in knowledge and confidence and, changes in attitude towards palliative care were used as measures of success. A forty two question true/false-style quiz was distributed pre- and post-workshop; this demonstrated a mean total score improvement of 15% post-workshop. Self-reported confidence rating scores regarding confidence when (i) managing palliative or end-of-life care patients, (ii) providing holistic care and (iii) breaking bad news increased by a mean of 25%.

Consequences

The greatest outcome from this workshop by far was the enthusiasm and awareness it generated; it highlighted the importance of developing this area of training for general practitioners in Myanmar. Support was also gained from the President of the Myanmar Medical Association whom delivered an opening speech at the workshop despite initially having reservations about developing this area. Ultimately, the positive feedback from the workshop behaved as an advocate leading to the introduction of a regular palliative care lecture into the Myanmar Diploma in Family Medicine curriculum. It has also spurred a new group of GPs to further this work and turn the workshop into a regular teaching event.