Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-14T13:31:29.964Z Has data issue: false hasContentIssue false
  • English
  • Français

Using a supportive care framework to understand and improve palliative care among cancer patients in Africa

Published online by Cambridge University Press:  15 June 2015

David S. Busolo  and
Roberta L. Woodgate
David S. Busolo*
Affiliation:
College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Roberta L. Woodgate
Affiliation:
College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
*
Address correspondence and reprint requests to: David S. Busolo, College of Nursing, Faculty of Health Sciences, University of Manitoba, 444-89 Curry Place, Winnipeg, Manitoba, Canada, R3 T 2N2. E-mail: busolod@myumanitoba.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Cancer incidence and mortality are increasing in Africa, which is leading to greater demands for palliative care. There has been little progress in terms of research, pain management, and policies related to palliative care. Palliative care in Africa is scarce and scattered, with most African nations lacking the basic services. To address these needs, a guiding framework that identifies care needs and directs palliative care services could be utilized. Therefore, using the supportive care framework developed by Fitch (Fitch, 2009), we here review the literature on palliative care for patients diagnosed with cancer in Africa and make recommendations for improvement.

Method:

The PubMed, Scopus, CINAHL, Web of Science, Embase, PsycINFO, Social Sciences Citation Index, and Medline databases were searched. Some 25 English articles on research from African countries published between 2004 and 2014 were selected and reviewed. The reviewed literature was analyzed and presented using the domains of the supportive care framework.

Results:

Palliative care patients with cancer in Africa, their families, and caregivers experience increasing psychological, physical, social, spiritual, emotional, informational, and practical needs. Care needs are often inadequately addressed because of a lack of awareness as well as deficient and scattered palliative care services and resources. In addition, there is sparse research, education, and policies that address the dire situation in palliative care.

Significance of Results:

Our review findings add to the existing body of knowledge demonstrating that palliative care patients with cancer in Africa experience disturbing care needs in all domains of the supportive care framework. To better assess and address these needs, holistic palliative care that is multidomain and multi-professional could be utilized. This approach needs to be individualized and to offer better access to services and information. In addition, research, education, and policies around palliative care for cancer patients in Africa could be more comprehensive if they were based on the domains of the supportive care framework.

Keywords

Palliative careAfricaCancerSupportive care framework
Type
Review Article
Information
Palliative & Supportive Care , Volume 14 , Issue 3 , June 2016 , pp. 284 - 301
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Alsirafy, S.A., El-Mesidi, S.M., El-Sherief, W.A., et al. (2011). Opioid needs of patients with advanced cancer and the morphine dose-limiting law in Egypt. Journal of Palliative Medicine, 14(1), 51–54.Google Scholar
Back, A.L., Arnold, R.M. & Quill, T.E. (2003). Hope for the best, and prepare for the worst. Annals of Internal Medicine, 138(5), 439–443.CrossRefGoogle ScholarPubMed
Bates, J., Gwyther, L. & Dinat, N. (2008). Morphine: Friend or foe? Malawi Medical Journal, 20(4), 112–114.Google Scholar
Bekelman, D., Rumsfeld, J., Havranek, E., et al. (2009). Symptom burden, depression, and spiritual well-being: A comparison of heart failure and advanced cancer patients. Journal of General Internal Medicine, 24(5), 592–598.CrossRefGoogle ScholarPubMed
Clark, D., Wright, M., Hunt, J., et al. (2007). Hospice and palliative care development in Africa: A multi-method review of services and experiences. Journal of Pain and Symptom Management, 33(6), 698–710.CrossRefGoogle Scholar
Clegg-Lamptey, J.N., Dakubo, J.C. & Attobra, Y.N. (2009). Psychosocial aspects of breast cancer treatment in Accra, Ghana. East African Medical Journal, 86(7), 348–353.Google ScholarPubMed
Donovan-Kicken, E. & Caughlin, J.P. (2011). Breast cancer patients' topic avoidance and psychological distress: The mediating role of coping. Journal of Health Psychology, 16(4), 596–606.CrossRefGoogle ScholarPubMed
Downing, J., Gwyther, L. & Mwangi-Powell, F. (2012). Public health and palliative care: A perspective from Africa. In International perspectives on public health and palliative care. Sallnow, L. et al. (eds.), pp. 70–84. London and New York: Routledge.Google Scholar
Elumelu, T.N., Adenipekun, A., Soyannwo, O., et al. (2013). Palliative care experience in breast and uterine cervical cancer patients in Ibadan, Nigeria. The Internet Journal of Pain, Symptom Control and Palliative Care. 10(1). Available from https://ispub.com/IJPSP/10/1/1557.Google Scholar
Eyelade, O.R., Ajayi, I.O., Elumelu, T.N., et al. (2012). Oral morphine effectiveness in Nigerian patients with advanced cancer. Journal of Pain & Palliative Care Pharmacotherapy, 26(1), 24–29.Google Scholar
Fan, S.Y., Lin, W.C. & Lin, I.M. (2014). Psychosocial care and the role of clinical psychologists in palliative care. The American Journal of Hospice & Palliative Care, pii: 1049909114543492. Epub ahead of print.Google ScholarPubMed
Fitch, M.I. (2008). Supportive care framework. The Canadian Oncology Nursing Journal, 18(1), 6–24.Google Scholar
Fitch, M.I. (2009). Supportive care framework: Theoretical underpinnings. In Supportive care framework: A foundation for person-centred care. Fitch, M.I. et al. (eds.), pp. 11–29. Pembroke, Ontario: Pappin Communications.Google Scholar
GLOBOCAN (2012). Estimated cancer incidence, mortality and prevalence worldwide in 2012. Available from http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.Google Scholar
Grant, L., Brown, J., Leng, M., et al. (2011 a). Palliative care making a difference in rural Uganda, Kenya and Malawi: Three rapid evaluation field studies. BMC Palliative Care, 10, 8.Google Scholar
Grant, L., Downing, J., Namukwaya, E., et al. (2011 b). Palliative care in Africa since 2005: Good progress, but much further to go. BMJ Supportive & Palliative Care, 1(2), 118–122.Google Scholar
Gysels, M., Pell, C., Straus, L., et al. (2011). End of life care in Sub-Saharan Africa: A systematic review of the qualitative literature. BMC Palliative Care, 10, 6. Available from http://www.biomedcentral.com/1472-684X/10/6.CrossRefGoogle ScholarPubMed
Hameed, K.A. (2011). Optimizing pain care delivery in outpatient facilities: Experience in NCI, Cairo, Egypt. Journal of Pediatric Hematology/Oncology, 33(Suppl. 1), S19–S22.CrossRefGoogle ScholarPubMed
Harding, R. & Higginson, I.J. (2005). Palliative care in Sub-Saharan Africa. Lancet, 365(9475), 1971–1977.CrossRefGoogle ScholarPubMed
Harding, R., Selman, L., Agupio, G., et al. (2011). The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries. European Journal of Cancer, 47(1), 51–56.CrossRefGoogle ScholarPubMed
Hearn, J. & Higginson, I.J. (1998). Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliative Medicine, 12(5), 317–332.CrossRefGoogle ScholarPubMed
Herce, M.E., Elmore, S.N., Kalanga, N., et al. (2014). Assessing and responding to palliative care needs in rural Sub-Saharan Africa: Results from a model intervention and situation analysis in Malawi. PLoS One, 9(10), 1–17.CrossRefGoogle Scholar
Hui, D., de la Cruz, M., Mori, M., et al. (2013). Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks. Supportive Care in Cancer, 21(3), 659–685.CrossRefGoogle ScholarPubMed
Hwang, S.S., Chang, V.T., Cogswell, J., et al. (2004). Study of unmet needs in symptomatic veterans with advanced cancer: Incidence, independent predictors and unmet needs outcome model. Journal of Pain and Symptom Management, 28(5), 421–432.CrossRefGoogle ScholarPubMed
Jack, B.A., Kirton, J., Birakurataki, J., et al. (2011). “A bridge to the hospice”: The impact of a community volunteer programme in Uganda. Palliative Medicine, 25(7), 706–715.CrossRefGoogle ScholarPubMed
Jagwe, J. & Merriman, A. (2007). Uganda: Delivering analgesia in rural Africa. Opioid availability and nurse prescribing. Journal of Pain and Symptom Management , 33(5), 547–551.Google Scholar
Jansen van Rensburg, J.J., Maree, J.E. & van Belkum, C. (2013). Quality of life from the perspective of the palliative care patient in a resource-poor community in South Africa. Palliative & Supportive Care, 11(1), 21–28.Google Scholar
Jemal, A., Bray, F., Forman, D., et al. (2012). Cancer burden in Africa and opportunities for prevention. Cancer, 118(18), 4372–4384.Google Scholar
Kamau, R.K., Osoti, A.O. & Njuguna, E.M. (2007). Effect of diagnosis and treatment of inoperable cervical cancer on quality of life among women receiving radiotherapy at Kenyatta National Hospital. East African Medical Journal, 84(1), 24–30.CrossRefGoogle ScholarPubMed
Kamuhabwa, A. & Ezekiel, D. (2009). Rational use and effectiveness of morphine in the palliative care of cancer patients at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11(4), 170–174.Google Scholar
Katumba, J., Obore, S. & Kaye, D.K. (2013). Health-related quality of life among patients with ovarian cancer at Mulago Hospital, Uganda. International Journal of Gynaecology and Obstetrics, 122(2), 115–117.CrossRefGoogle ScholarPubMed
King, D.A. & Quill, T. (2006). Working with families in palliative care: One size does not fit all. Journal of Palliative Medicine, 9(3), 704–715.CrossRefGoogle Scholar
Lam, W.W.T., Law, C.C., Fu, Y.T., et al. (2008). New insights in symptom assessment: The Chinese versions of the Memorial Symptom Assessment Scale–Short Form (MSAS–SF) and the Condensed MSAS (CMSAS). Journal of Pain and Symptom Management, 36(6), 584–595.Google Scholar
Lavy, V. (2007). Presenting symptoms and signs in children referred for palliative care in Malawi. Palliative Medicine, 21(4), 333–339.CrossRefGoogle ScholarPubMed
Logie, D.E. & Harding, R. (2005). An evaluation of a morphine public health programme for cancer and AIDS pain relief in Sub-Saharan Africa. BMC Public Health, 5, 82. Available from 10.1186/1471-2458-5-82.Google Scholar
Mabena, N. & Moodley, P. (2012). Spiritual meanings of illness in patients with cervical cancer. South African Journal of Psychology, 42, 301–311. Available from http://sap.sagepub.com/content/42/3/295.refs.CrossRefGoogle Scholar
Machira, G., Kariuki, H. & Martindale, L. (2013). Impact of an educational pain management programme on nurses pain knowledge and attitudes in Kenya. International Journal of Palliative Nursing, 19(7), 341–346.Google Scholar
Malloy, P., Paice, J.A., Ferrell, B.R., et al. (2011). Advancing palliative care in Kenya. Cancer Nursing, 34(1), E10–E13.Google Scholar
Masika, G.M., Wettergren, L., Kohi, T.W., et al. (2012). Health-related quality of life and needs of care and support of adult Tanzanians with cancer: A mixed-methods study. Health and Quality of Life Outcomes, 10, 133.Google Scholar
Merriman, A. & Harding, R. (2010). Pain control in the African context: The Ugandan introduction of affordable morphine to relieve suffering at the end of life. Philosophy, Ethics, and Humanities in Medicine, 5, 10.Google Scholar
Murray, S.A., Grant, E., Grant, A., et al. (2003). Dying from cancer in developed and developing countries: Lessons from two qualitative interview studies of patients and their carers. BMJ, 326(7385), 368–368.Google Scholar
Mwanda, W.O., Abdallah, F.K., Obondo, A., et al. (2004). Quality of life in male cancer patients at Kenyatta National Hospital, Nairobi. East African Medical Journal, 81(7), 341–347.Google Scholar
Mwangi-Powell, F. (2012). APCA's role in the development of palliative care in Africa. Progress in Palliative Care, 20, 230–233.Google Scholar
Mwangi-Powell, F. & Dix, O. (2011). Palliative care in Africa: An overview. Africa Health, 33(5), 19–21.Google Scholar
Mwangi-Powell, F., Downing, J., Ddungu, H., et al. (2010). Palliative care in Africa. In Textbook of palliative nursing, Ferrell, B.R. & Nessa, C. (eds.), pp. 1319–1329. New York: Oxford University Press.CrossRefGoogle Scholar
Mwangi-Powell, F.N., Powell, R.A. & Harding, R. (2013). Models of delivering palliative and end-of-life care in Sub-Saharan Africa: A narrative review of the evidence. Current Opinion in Supportive and Palliative Care, 7(2), 223–228.Google Scholar
Nwankwo, K.C. & Ezeome, E. (2011). The perceptions of physicians in southeast Nigeria on truth-telling for cancer diagnosis and prognosis. Journal of Palliative Medicine, 14(6), 700–703.Google Scholar
Paice, J.A., Ferrell, B., Coyle, N., et al. (2010). Living and dying in East Africa. Clinical Journal of Oncology Nursing, 14(2), 161–166.Google Scholar
Philips, P.L. & Lazenby, M. (2013). The emotional and spiritual well-being of hospice patients in Botswana and sources of distress for their caregivers. Journal of Palliative Medicine, 16(11), 1438–1445.Google Scholar
Powell, R.A., Namisango, E., Gikaara, N., et al. (2014). Public priorities and preferences for end-of-life care in Namibia. Journal of Pain and Symptom Management, 47(3), 620–630.Google Scholar
Selman, L., Higginson, I.J., Agupio, G., et al. (2009). Meeting information needs of patients with incurable progressive disease and their families in South Africa and Uganda: Multicentre qualitative study. BMJ, 338(7703), 1127–1131.Google Scholar
Selman, L.E., Higginson, I.J., Agupio, G., et al. (2011). Quality of life among patients receiving palliative care in South Africa and Uganda: A multi-centered study. Health and Quality of Life Outcomes, 9, 21.Google Scholar
Tapsfield, J.B. & Jane Bates, M. (2011). Hospital-based palliative care in Sub-Saharan Africa; A six-month review from Malawi. BMC Palliative Care, 10, 12. Available from http://www.biomedcentral.com/1472-684X/10/12.Google Scholar
Tazi, I. (2011). Palliative care for patients with hematological malignancies in Morocco: A real challenge. Journal of Palliative Medicine, 14(3), 270. Available from http://connection.ebscohost.com/c/articles/58722578/palliative-care-patients-hematologic-malignancies-morocco-real-challenge.CrossRefGoogle Scholar
Tranmer, J.E., Heyland, D., Dudgeon, D., et al. (2003). Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the Memorial Symptom Assessment Scale. Journal of Pain and Symptom Management, 25(5), 420–429.CrossRefGoogle ScholarPubMed
Vastag, B. (2006). Developing countries face growing cancer burden. Journal of the National Cancer Institute, 98(16), 1106–1107.Google Scholar