Advanced cancer patients' experience and perception of advance care planning at a university teaching hospital in Northern Tanzania.

Abstract

Background: Advance care planning (ACP) is not formally implemented in Tanzanian healthcare. While the burden of non-communicable diseases continues to rise, most patients present at advanced stages of illness, highlighting the urgent need for ACP to support preference-based care.

Objectives: This study aimed to explore advanced cancer patients' experiences and perceptions of ACP at a university teaching hospital in Northern Tanzania. Findings may inform the contextual relevance and acceptability of ACP tools in low-resource settings.

Methods: This qualitative study employed individual in-depth interviews with eight patients diagnosed with advanced cancer at Kilimanjaro Christian Medical Centre. Participants received a translated version of the Five Wishes document to read and discuss with their families at home prior to the interviews. A phenomenological approach guided the data collection and analysis. Interviews were conducted in Swahili, transcribed verbatim, translated into English, and thematically analyzed using an inductive coding process by two researchers.

Results: Four key themes emerged: (1) nature of acceptance, (2) challenges to uptake and utilization of ACP, (3) modality and timing of conversations, and (4) strategies for effective integration into clinical care. While initial hesitation was common, participants generally found ACP relevant and valuable for family harmony, future preparation, and quality of life.

Conclusion: Despite limited awareness and sociocultural taboos around death, ACP was viewed as meaningful by patients with advanced illness. Further studies are needed to evaluate culturally appropriate adaptations and implementation strategies for ACP in the Tanzanian context.