Awareness and knowledge of palliative care in Tripoli, Lebanon: A cross-sectional study in a disadvantaged population

Palliative care access remains limited in Lebanon, particularly outside the capital. Data on public palliative care knowledge and perceptions in general and among disadvantaged populations remain insufficient.

This study aimed to assess palliative care awareness and knowledge among community users of a non-governmental organization serving socioeconomically disadvantaged populations in Tripoli, north of Lebanon.

A cross-sectional study was conducted using a structured survey targeting 400 individuals using the Palliative Care Knowledge Scale (PaCKS) in the colloquial Arabic language. Data on palliative care awareness and background information were collected. Multivariable binary logistic regression using stepwise backward selection was conducted to identify predictors associated with palliative care knowledge levels and common misconceptions.

Low awareness of palliative care was observed, with 95.8% of participants reporting never having heard of it. PaCKS's mean score was 9.24 ± 2.89; 40.8% (N = 163) had high scores (11-13), 42.8% (N = 171) had moderate scores (7-10), and 16.5% (N = 66) had low scores (0-6). Common misconceptions included perceiving palliative care to be limited to hospital care, to cancer, and to end of life. Higher educational attainment was a strong and stable predictor of palliative care knowledge and common misconceptions. Participants with middle or high school education had 1.754 higher odds (p = 0.013), and those with university education had 4.938 higher odds (p < 0.001) for higher knowledge compared to participants with no or primary education, potentially indicating a graded association. More than half of the participants expressed interest in having information about palliative care made generally available.

Our results indicate low awareness and several misconceptions about palliative care along with the presence of health inequities. Low educational attainment, mainly linked to socioeconomic disadvantage, may limit health literacy, and as such, reduce access to information and the ability to understand complex concepts such as palliative care. These findings highlight the urgent need for a collaborative, multi-sectoral system-thinking, community-centered, and equity-driven approach that involves the community, researchers, healthcare providers, and policymakers.