Provision of palliative care for life-limiting disease in a low income country national hospital setting: how much is needed?
- 1St. Christopher's Hospice, London, UK
- 2Palliative Care Unit, Department of Medicine, Mulago Hospital, Kampala, Uganda
- 3Department of Palliative Care, Policy and Rehabilitation, Kings College London, Cicely Saunders Institute, London, UK
- Correspondence to Jane Rachel Lewington, St. Christopher's Hospice, London, UK;
Contributors JLewington designed the study, collected and analysed data, managed data collection and drafted the manuscript. EN and ML assisted design, collected data, assisted in interpretation and commented on drafts. JLimoges assisted design and managed data collection. RH assisted with study design and commented on drafts. All authors read and approved the final manuscript.
Objectives This study aimed to measure the magnitude of palliative care needs among hospital inpatients. Objectives were to: (1) determine the point prevalence of inpatients with active life-limiting disease and (2) describe multidimensional need for palliative care among these patients.
Methods The study was a hospital inpatient census in Uganda. Patient notes were surveyed and those patients identified as having an active life-limiting disease were interviewed. Multidimensional palliative care need was assessed using the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS).
Results 122/267 (46%) patient notes were found to indicate an active life-limiting disease. Diagnoses were; HIV/AIDS (74/122, 61%), cancer (22/122, 18%), heart failure (11/122, 9%), renal failure (11/122, 9%), liver failure (3/122, 2%) and chronic obstructive pulmonary disease (1/122, 1%). A total of 78/122 patients consented to be interviewed. Most patients reported multidimensional need in the three most negative of six categories for any APCA African POS question (75/78, 96%). Social problems included an inability to work (72/78, 92%), having unaffordable medical expenses (39/78, 50%) and limited access to food (11/78, 14%). Of those with a faith (76/78), more than a third (29/78, 38%) expressed the need for increased faith support.
Conclusions The prevalence of active life-limiting disease reported here (46%) is greater than in comparable European studies (5–23%).This reflects the sub-Saharan increased disease prevalence, presentation at a later stage and limited access to curative therapies. There is need for symptom control, food, financial assistance and spiritual support. Service development should be tailored to meet these needs.
Competing interests None.
Ethics approval Approval provided by the Makerere University Research and Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
- Accepted 19 March 2012.
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