Awareness and Predictors of Uptake of Palliative Care Services Among Patients With Advanced Cancer Attending Kenyatta National Hospital

Abstract

Background: Life-limiting cancer has a profound effect on the individual and their family member's health and well-being. The effects can range from psychological, physical, social and spiritual health of the patients leading to a diminished quality of life and poor treatment outcomes. Palliative care (PC) plays a critical supportive care role in alleviating the symptom burden, reduce the psychosocial distress and improve the health-related quality life for patients with serious and life-threatening advanced cancer. Integration of palliative care and standard oncology care have been proven to confer better survival outcomes and better quality of life for patients with cancer. Little is known about palliative care awareness and uptake among patients with advanced cancer in sub-Saharan region. Objectives: To investigate the level of awareness, proportion of uptake, predictors of uptake and barriers of uptake of palliative care among patients with advanced cancer attending outpatient care at KNH. Methods: This was a descriptive cross-sectional study to assess the level of awareness and uptake of palliative care among patients with advanced cancer attending care at CTC, KNH. Data was collected through a structured researcher administered questionnaire to 173 participants. The data was analyzed using SPSS version 26, presented using mean, frequency distribution, percentages and standard deviation. Multi-variate logistic regression was used to investigate the relationship between dependent and independent variables. The Kenyatta National Hospital- University of Nairobi Ethics and review committee (KNH-UON) granted ethical approval, permission to collect data granted by Head of department, cancer treatment center. Results: The response rate was 92% with the majority of participants being female (62%). The mean age for the respondents was 54 ± 14 years. Overall, Palliative awareness was 34%. There was a significant association between the social demographic and clinical factors and awareness of PC with a (P= 0.04). Patients with high level of education had a high odds of PC awareness. Most 29.5% of the patients with PC awareness heard it from the attending oncologist. Majority 29% stated that the goal of palliative care is to help them cope with symptom management. Palliative care uptake was 31% among patients with advanced cancer, 60% of this were recommended by the attending oncologist. Further analysis revealed that women are likely to utilize Palliative care services. The most cited barriers for PC utilization were lack of funds for consultation fee 77% and lack of money for transport 69%. Conclusion: The low awareness and uptake of palliative care services among cancer patients highlight the need to introduce interventions aimed at improving the general awareness and uptake of PC. We recommend implementation of models aimed at integrating PC to standard oncology care.