The practice of advance care planning among ambulatory cancer patients at a tertiary hospital in Kenya: descriptive cross-sectional survey.

Abstract

Background: Advance care planning (ACP) is relevant in the care of cancer patients. Insight into the current practice of ACP can identify high-priority areas to direct interventions aimed at improving the process.

Objective: To assess the practice of ACP among ambulatory cancer patients at a Kenyan hospital.

Methodology: A descriptive cross-sectional survey was conducted at the ambulatory oncology clinic at a tertiary referral hospital. We recruited 387 study participants through consecutive sampling among heterogenous cancer patients. An interviewer-administered questionnaire was used to collect data, which was analysed by SPSS version 25 and through multivariable logistical regression.

Results: Among 387 participants, 78.55% were females. The uptake of advance directives was low; only 27.13% of participants had appointed surrogate decision makers, while 1.5% had living wills. Few had discussed end-of-life wishes with family (28.68%) and doctors (19.63%). Only 27.39% had discussed life expectancy with a doctor. Among those who had not participated in ACP, most were willing to discuss life expectancy (71.9%); discuss end-of-life wishes with family (81.2%) and doctors (85.1%); complete advance directives (68%) and appoint surrogate decision makers (75.9%) in the next 1 month. Doctors were most preferred to initiate ACP discussions. Factors that positively correlated with uptake of advanced directives (ADs) included - ECOG status, discussion with family and with doctors.

Conclusion: The uptake of ADs among ambulatory cancer patients was low; additionally, self-reported participation in ACP was low. Our study highlights the need for widespread education initiatives and standardisation of the ACP process.

Recommendations: There is a need for further studies and strategies to improve the participation in ACP and hence the quality of life among patients with malignancies in Kenya.