Abstract

Background: Palliative care in Kenya is not funded as a national resource and is therefore offered by Hospices and Palliative care units that rely on funding from charities or non-governmental organizations (NGOs). Although access to palliative care is limited as a whole adult palliative care is more developed, with 65 centres offering this service either as stand-alone units or integrated services compared to a single centre offering paediatrics palliative care in the entire country (Garissa county referral hospital established in 2011). Assessment over a three months period in M.P Shah Hospital in Nairobi revealed that 14 children were admitted with diagnosis of life limiting illnesses. This makes an average of 4 children monthly who need palliative care services, with no dedicated service.

Objective: To integrate Paediatrics palliative care services at the M.P Shah Hospital.

Methodology: The project has started off with a cross sectional descriptive study over a two week period to assess the knowledge of healthcare professionals in the Paediatrics department. After getting ethical approval form the hospital committee, all permanent staff was invited to participate. Data was collected using a validated tool; the Palliative Care Quiz for Nurses. Good knowledge was defined as >75% score. Part two of the project is training health care providers on paediatrics palliative care and the final phase is offering the services which will include formal clinic days and ward reviews with a proper referral system.

Results: Out of 50 staff, 30 met the inclusion criteria; 4 declined consent and 5 did not return completed questionnaires thus 21 anonymously self-administered questionnaires were analyzed. 71.5% (15) of the participants were nurses; 19.04 % (4) were consultant pediatricians and 9.5% (2) senior registrars. 52.3% (11) had postgraduate qualification in either paediatrics or critical care.

85.71% (18) had no previous experience with hospice or palliative care and 90.47% had no previous training in palliative care. All of the participants had poor knowledge on palliative care scoring < 75%. 16.9% (14) Scored > 50% while 33.3% (7) < 50%. Respondents scored higher on questions related to pain and symptom management.

Conclusion: There was overall poor knowledge in palliative care attributed to lack of formal training, which is to be addressed in the next phase of the project through targeted short course trainings.

Keywords: Knowledge; Attitudes; Practice; Health Care Workers; Paediatric Palliative Care

References

1. Goldman A., et al. “Oxford textbook of palliative care for children”. Oxford University Press (2006).
2. Israels T., et al. “Strategies to improve care for children with cancer in Sub-Saharan Africa”. European Journal of Cancer11 (2010): 1960- 1966.
3. Downing JD., et al. “Developing children’s palliative care in Africa through beacon centres: lessons learnt”. BMC Palliative Care1 (2013): 8.
4. Harding R., et al. “Paediatric palliative care in sub- Saharan Africa: a systematic review of the evidence for care models, interventions, and outcomes”. Journal of Pain and Symptom Management3 (2014): 642-651.
5. WHO (World Health Organization). 2002. WHO Definition of Palliative Care (2020).
6. Ross M., et al. “The Palliative Quiz for Nursing (PCQN): development of an instrument to measure nurses knowledge of palliative care”. Journal of Advanced Nursing 23 (1996): 126-137.
7. Brazil K., et al. “Knowledge and perceived competence among nurses caring for the dying in long-term care homes”. International Journal of Palliative Nursing2 (2012): 77- 83.
8. Kenya Hospices and Palliative Care Association website.
9. Brajtman S., et al. “Survey of educators’ end-of-life care learning needs in a Canadian baccalaureate nursing program”. International Journal of Palliative Nursing5 (2009): 233-241.
10. Maria K., et al. “Assessment of Knowledge and Associated Factors towards Palliative Care among Greek Nurses”. World Journal of Social Science Research3 (2016): 381.