Preparing Future Doctors for Palliative and End of Life Care in Kenya: Cross-sectional Survey

Abstract

Purpose: The main aim of this study was to assess how prepared are Kenyan doctors in delivering palliative and end of life care to chronic and life-threatening conditions. Methodology: Cross-sectional survey was used to assess doctor’s palliative and end of life practices. Multi-center (three-mission referral and teaching hospitals in Kenya): Tenwek, Kijabe, and Chogoria were used to collect data from 96 medical practioners. Medical doctors with at least 6 months managing patients with chronic conditions (cancer, HIV/AIDS and other life-threatening conditions) were recruited into the study. The quantitative data was analysed using an independent t-test. All ethical considerations were addressed. Findings: Majority of doctors interviewed were generalists who had managed chronic diseases. Majority had basic concepts of palliative care and end of life care. Those who had received prior training in palliative care were better in performance’s score on knowledge questions regarding palliative care and end of life. Medical doctors were knowledgeable on psychological distress and opioids effects domains as compared to delirium and dyspnea domains. Among those who were knowledgeable in palliative care and end of life care were doctors trained outside Kenya, those who were senior with more experiences (>10 years), over 40 years and had further training after their undergraduate Unique Contribution to Theory, Practice and Policy: This study seeks to develop training tailored to Kenyan doctors and Physicians on end-of-life care practices in selected counties then roll-out to the rest of the counties in the country in collaboration with Ministry of Health Kenya and also provide opportunities for doctors to develop palliative and end-of-life care skills especially for resident and junior doctors. This study will also form basis for policy development on palliative and end-of-life care practices in Kenya, which currently is non-existent. End-of-life care Policy would aid in clinical application of good practices surrounding palliative and end-of-life care which should be implemented in Kenya. This study advocates inclusion of end-of-life care training modules in a standardized curriculum for undergraduate as part of training and preparing future Kenyan doctors. Further, this study can be considered as current Physician’s approach to end-of-life care practices in Kenya which then can be a basis to develop guidelines and standards addressing end-of-life which is fraught with ethical and medical dilemmas carried by healthcare professionals.