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18TH – 20TH SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

10TH ONCOLOGY NURSES CHAPTER CONFERENCE

Awareness and predictors of uptake of palliative care among patients with advanced cancer at oncology units in a teaching and referral hospital in Kenya

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Presenters/Authors: Solomon Mirera Omare (KNH)

Prof S.T. Kimani (UoN)

Dr. S Wakasiaka (UoN)

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Affiliation(s): Kenyatta National Hospital

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Background

  • Cancer is one of the leading causes of morbidity and mortality globally
    • Globally, an estimated incidence of 19million and a mortality of over 10Million was reported in GLOBBOCAN 2020 (Sung et al., 2021)
  • Cancer and its treatment pose a significant symptom burden that impacts the health related quality of life across the care continuum (Hui et al., 2015)
  • Integrating supportive and palliative care to standard has been shown to confer great survival benefit and improved quality of life (Chang et al., 2022)

18th – 20th SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

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Background.

  • Many patients endures a physical, mental, social, cognitive and spiritual impairment during cancer diagnosis, treatment and survivorship (Pergolloti et al., 2017).
  • Palliative care provides a holistic approach to address the above impairments.
  • Large unmet need for palliative care services for patients with advanced cancer standing at 83% in Kenya (KEHPCA, 2020).
  • This study therefore set to explore the level of awareness and uptake of palliative care among patients with advanced cancer at KNH.

18th – 20th SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

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Objectives

  • Broad Objective
    • To investigate awareness and the predictors of uptake of palliative care services among patients with advanced cancer attending Kenyatta national hospital.
  • Specific Objectives
    1. To determine the level of awareness of palliative care among patients with advanced cancer attending Kenyatta national hospital
    2. To determine the level of uptake of palliative care services among patients with advanced cancer at the Kenyatta National Hospital.
    3. To identify the predictors of uptake of palliative care services among patients with advanced cancer at the Kenyatta National Hospital.
    4. To establish the perceived barriers of uptake of palliative care services at the Kenyatta National hospital.

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18th – 20th SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

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Methodology

Study area KNH’s Cancer Treatment Center (CTC).

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Study design Hospital based cross sectional descriptive study.

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Study population : All patients diagnosed with cancer.

Inclusion criteria: Patients clinical stage of cancer stage III and stage IV.

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Exclusion criteria Patients who were critically ill

First timer patients at KNH

Patients who did not consent.

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18th – 20th SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

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Methodology

Sampling procedure: Consecutive sampling method

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Recruitment procedure: Eligible participants were identified from the clinic register

Participants were informed about the study, its aims and procedures

Participant consented at the beginning of the data collection

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Research instrument: Structured researcher administered questionnaire

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Pretesting Done at KNH’s gynaecology clinic.

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Data collection process Data was collected by three trained research assistants and the PI

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18th – 20th SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

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18th – 20th SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

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18th – 20th SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

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�AWARENESS OF PALLIATIVE CARE SERVICES�

18th – 20th SEPTEMBER 2024

Advancing Access To Comprehensive Cancer Care In The Context Of UHC.

Characteristic

Full sample N=173

Awareness of PC services

58 (34%)

Source of PC awareness N=58

Personally received PC

Doctor/ health care provider

Family or friend

Media

Personal research

 

 

 

8 (13%)

35 (60%)

 

5 (8%)

4(6%)

9 (15%)

Was PC recommended to you by the health care provider?

Yes

no

 

 

 

39 (23%)

134 (77%)

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Results

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Uptake of palliative care

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Results

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Palliative care services received.

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Point of service, onset and frequency of palliative care.

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Results

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Relationship between social demographic factors and uptake of palliative care.

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Results

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Barriers to uptake of palliative care.

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Discussions

  • The level of awareness of palliative carre among the study participants was low at 34%. The trends seem to be similar in low and middle income countries, in Asia had similar findings (30%) (Ozdermir et al., 2022). Results are a contrast to high income countries with over 77% awareness level.

  • There was a low uptake of palliative care (30%). Also similar in LMIC like Asia (34%), China (19%) Ozdemir., 2022 & Lin et al., 2022). The findings contrast findings from HIC with US recording over 50% (Hui., 2014).

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  • The level of education is a significant impact on the level of awareness of palliative care, results reported by Ozdemir et al.,2022 and Chang et al., 2020). Gender had significant impact on the uptake where women are likely to utilize palliative care (Kimani., 2015)

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  • Major barriers to uptake of palliative care relate to costs, WHO identifies lack of integration, financial inaccessible services and unsupportive policies as the key barriers to uptake of palliative care (WHO., 2018). Similar findings in Ethiopia where Abate et al., (2023) highlights cost constraints as major hindering factor.

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Conclusions & Recommendations

  • Integrating palliative care services with standard oncology care at Kenyatta National Hospital.

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  • Further research on impact of palliative care on patients with Cancer at Kenyatta National Hospital.

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  • Leveraging on the Navigation program at KNH to increase the cancer support services available for cancer patients.

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We recommend that;

  • Patients with advanced cancer attending care at KNH had low levels of awareness regarding palliative care.

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  • There was low uptake of palliative care among patients with advanced cancer at KNH.

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  • Patients with a higher level of education had a high odds of palliative care awareness. Social demographic and clinical factors did not have any significant impact on the uptake of palliative care services at KNH.

  • Lack of money is a significant barrier in the uptake of palliative care services.

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Selected References

Delgado-Guay, M.O. et al. (2018) ‘Characteristics and Outcomes of Advanced Cancer Patients Who Received Palliative Care at a Public Hospital Compared with Those at a Comprehensive Cancer Center’, Journal of Palliative Medicine, 21(5), pp. 678–685. Available at: https://doi.org/10.1089/jpm.2017.0236.

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Kimani, C. (2015) Factors influencing progressive utilization of palliative care services among Cancer patients in Kenya: The case of Nairobi hospice. Thesis. University of Nairobi. Available at: http://erepository.uonbi.ac.ke/handle/11295/93042 (Accessed: 22 July 2022).

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Kumar, P. et al. (2012) ‘Utilization of Supportive and Palliative Care Services among Oncology Outpatients at One Academic Cancer Center: Determinants of Use and Barriers to Access’, Journal of Palliative Medicine, 15(8), pp. 923–930. Available at: https://doi.org/10.1089/jpm.2011.0217.

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Hui D. et al. (2012) ‘Access to Palliative Care Among Patients Treated at a Comprehensive Cancer Center’, The Oncologist, 17(12), pp. 1574–1580. Available at: https://doi.org/10.1634/theoncologist.2012-0192.

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