UCSF

Introduction: The purpose of this study was to explore palliative care provider self-competence, ethical concerns and priorities for education and training in an inpatient hospice setting in Kenya. Momentum is building in sub-Saharan Africa to improve the provision of palliative care services. However, provider perspectives are poorly understood. We hypothesized that mean self-competence and ethical concerns scores would differ according to provider type. Methods: A descriptive, cross-sectional study design was piloted at Kimbilio Hospice, a 26-bed, rural, inpatient facility in Kenya. A quantitative survey instrument entitled, "Self assessment of clinical competency and concerns in end-of-life care," was adapted for this setting and administered to participants by two research interviewers. Survey responses were collected from clinical staff, caregivers and support staff. Self-competence scores were reported as means for each variable in the Clinical Care and Patient and Family Interactions categories. Ethical concern scores were grouped by clinical scenario and ethical concern type. Data was analyzed using Kruskal Wallis to compare between means according to provider type. Results: The sample included 24 providers, with five clinical staff, 11 caregivers and eight support staff. Kruskal Wallis testing revealed statistically-significant differences between mean scores in five self-competence variables: performing a basic pain assessment, use of oral opioid analgesics, assessment and management of nausea/vomiting and constipation, and discussing an end-of-life prognosis with a patient's family member (p<0.05). The highest mean self-competence score for clinical staff was 4 for the use of oral opioid analgesics. The lowest scores were 2.8 for discussing inpatient hospice referral, use of IV opioid analgesics and assessment of pain in pediatric patients. Palliative care staff had the highest mean ethical concern score that withdrawing ventilator support from a dementia patient at the request of a family member would violate ethical norms of the community (mean=3.29, SD=1.04). Sixteen providers (21%) selected pediatric palliative care as their top priority for future education. Discussion: Our results support the hypothesis that palliative care providers have varying levels of self-competence. Improving educational and training programs to build palliative care competencies in pediatric palliative care and ethics in sub-Saharan Africa are recommended based on these findings.