Public preferences and priorities for end-of-life care in Kenya: a population-based street survey

Abstract

BackgroundEnd-of-life care needs are great in Africa due to the burden of disease. This study aimed to explore public preferences and priorities for end-of-life care in Nairobi, Kenya.MethodsPopulation-based street survey of Kenyans aged ≥18; researchers approached every 10th person, alternating men and women. Structured interviews investigated quality vs. quantity of life, care priorities, preferences for information, decision-making, place of death (most and least favourite) and focus of care in a hypothetical scenario of serious illness with <1 year to live. Descriptive analysis examined variations.Results201 individuals were interviewed (100 women) representing 17 tribes (n = 90 44.8%, Kikuyu). 56.7% (n = 114) said they would always like to be told if they had limited time left. The majority (n = 121, 61.4%) preferred quality of life over quantity i.e. extending life (n = 47, 23.9%). Keeping a positive attitude and ensuring relatives/friends were not worried were prioritised above having pain/discomfort relieved. The three most concerning problems were pain (45.8%), family burden (34.8%) and personal psychological distress (29.8%). Home was both the most (51.1% n = 98) and least (23.7% n = 44) preferred place of death.ConclusionThis first population-based survey on preferences and priorities for end-of-life care in Africa revealed that psycho-social domains were of greatest importance to the public, but also identified variations that require further exploration. If citizens’ preferences and priorities are to be met, the development of end-of-life care services to deliver preferences in Kenya should ensure an holistic model of palliative care responsive to individual preferences across care settings including at home.

Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya

“…The decisions on end of life care are preferably deferred to family members or community elders [9]. In Kenya, for example, 68.2% of respondents in one study indicated they would like a relative to be involved in end of life decision making [10]. The study was a population-based survey of public preferences and priorities for end of life care in Kenya done in Nairobi and Western Kenya.…”

Response to ‘Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries’

“…Third, an important variable in analysis of place of death might be the availability of palliative care services. In Africa, preference for dying at home4 5 was found to be lower than that in Europe,6 using similar study methods. In low and middle income settings where palliative care coverage is poor, and few health resources are available in the home, a home death could potentially be a very poor death indeed.…”

Death in a Mission Hospital

“…[8][9][10][11][12] Surveys have suggested that Kenyans want to know if their lives will end soon and want their families to be involved in the discussion. 13 Patients of many cultures consider spirituality to be important by the end of their lives, 4,5,14-16 and palliative-care patients who consider themselves to be more spiritually-oriented also tend to report less spiritual pain, depression, and anxiety. 17,18 Therefore, we should overcome our perceived awkwardness in approaching the subject of death and provide the spiritual balm our patients need.…”