Integration of Palliative Care Into Comprehensive Cancer Treatment at Moi Teaching and Referral Hospital in Western Kenya

Abstract

PurposeThe prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital.MethodsThis is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to identify current challenges and opportunities for program improvement.ResultsThis study documents the implementation of a palliative care service line in Eldoret, Kenya. Barriers to providing optimal palliative cancer care include distance to pharmacies that stock opioids, limited selection of opioid preparations, education of health care workers in palliative care, access to palliative chemoradiation, and limited availability of outpatient and inpatient hospice services.ConclusionPalliative care services in Eldoret, Kenya, have become a key component of its comprehensive cancer treatment program.

End-of-Life Palliative Care Practices and Referrals in Uganda

“…While such integration should be informed by recent international consensus regarding palliative integration, 37 it must also account for potential obstacles unique to resource-limited settings. 16,38 Specific and locally relevant parameters are needed to guide early collaboration with palliative specialists and to help oncologists decide whom to refer.…”

Approaches to integrating palliative care into African health systems: a qualitative systematic review

“…This was facilitated using referrals and members from the PC team attending ward rounds or offering consultations on symptom management. ‘Outpatient clinics’: many interventions used this mechanism to integrate PC into a facility, ( Molyneux et al , 2013 ; DesRosiers et al , 2014 ; Cornetta et al , 2015 ; Lowther et al , 2015 ; Zipporah, 2016 ; Gwyther et al , 2018 ). Usually individuals were seen together with their caregiver; however group outpatient clinics were also described ( DesRosiers et al , 2014 ).…”

“…These were often home visits ( Herce et al , 2014 ), according to set criteria, such as those whose mobility is heavily effected ( Hongoro and Dinat, 2011 ) and children whose caregivers could not carry them in ( Amery et al , 2009 ), and also found in the form of mobile clinics ( Herce et al , 2014 ), visits to other facilities, such as children homes ( Amery et al , 2009 ) and other health centres ( Tapsfield and Bates, 2011 ). ‘Telephonic advisory service’: telephonic consultations were used to manage patients’ symptoms at home ( Hongoro and Dinat, 2011 ; Cornetta et al , 2015 ) and to provide follow-up and bereavement calls ( Gwyther et al , 2018 ). ‘Treatment plans’: specialist PC teams often developed care plans that would be used while the patient is in the facility and following discharge.…”

“…‘Telephonic advisory service’: telephonic consultations were used to manage patients’ symptoms at home ( Hongoro and Dinat, 2011 ; Cornetta et al , 2015 ) and to provide follow-up and bereavement calls ( Gwyther et al , 2018 ).…”

“…Macro-level interventions typically involved the APCA ( Freeman et al , 2016 ; Grant et al , 2017 ; Kamonyo, 2018 ), recognized as an influential organization that supported PC development in Africa ( Paice et al , 2010 ; Rhee et al , 2018 ) and initiated national PC associations ( Molyneux et al , 2013 ). PC associations often led PC integration interventions ( Sithole and Dempers, 2010 ; Freeman et al , 2016 ; Zipporah, 2016 ; Krakauer et al , 2018 ) or supported implementation by providing advocacy ( Downing et al , 2013 ), technical support ( Lohman and Amon, 2015 ) and training ( Cornetta et al , 2015 ; Lowther et al , 2015 ; Gwyther et al , 2018 ), and ensuring accountability once the intervention was complete, improving sustainability ( Drenth et al , 2018 ). Participation of government and hospital staff in PC associations facilitated integration by linking staff with a broader network of PC ( Molyneux et al , 2013 ).…”