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      End-of-Life Palliative Care Practices and Referrals in Uganda

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          Abstract

          Background: While early involvement and integration of palliative care with oncology can positively impact quality of life and survival of patients with advanced cancer, there is a dearth of information regarding this integration in sub-Saharan Africa.

          Objective: We sought to describe the rate and factors predicting specialist palliative referrals among cancer patients in Uganda.

          Design: We examined the rate of referrals of cancer patients to palliative specialists via a chart review, while also surveying and interviewing doctors at the Uganda Cancer Institute (UCI) about their approaches to palliative care.

          Setting: All adult patients at the UCI who died in a 20-month interval from 2014 to 2015. All UCI doctors were approached for the survey and 25 (96%) participated. Seven of these doctors were also individually interviewed.

          Measurements: Number of referrals to palliative specialists and qualitative responses to questions about end-of-life care management.

          Results: Sixty-six (11.1%) of 595 patients were referred to palliative care specialists. Patients with worse ECOG performance statuses were more likely to be referred to palliative specialists (odds ratio 2.23, p = 0.03); no other factors were predictive of a referral. Median number of days lived after referral was 5 days (interquartile range 2–13). Doctors explained the low referral rate and short life expectancy after referral by limited palliative resources and a reticence to have end-of-life management conversations with patients due to cultural taboos.

          Conclusion: Despite recognized benefits of palliative collaboration, doctors at the UCI seldom refer patients to palliative care specialists due to limited staffing, cultural barriers, and difficult interservice communication.

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          Author and article information

          Journal
          J Palliat Med
          J Palliat Med
          jpm
          Journal of Palliative Medicine
          Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
          1096-6218
          1557-7740
          01 March 2018
          01 March 2018
          : 21
          : 3
          : 328-334
          Affiliations
          [ 1 ] University of Washington School of Medicine , Seattle, Washington.
          [ 2 ] Fred Hutchinson Cancer Research Center , Seattle, Washington.
          [ 3 ] Uganda Cancer Institute , Kampala, Uganda.
          [ 4 ]Makerere/Mulago Palliative Care Unit, Mulago Hospital , Kampala, Uganda.
          Author notes

          Current affiliation for DL: Department of Family Medicine, Swedish Cherry Hill Family Medicine Residency, Seattle, Washington.

          Address correspondence to: Daniel Low, MD, Department of Family Medicine Swedish Cherry Hill Family Medicine Residency, 550 16th Avenue, Suite 400, Seattle, WA 98122, E-mail: danielhlow@ 123456gmail.com
          Article
          PMC5863079 PMC5863079 5863079 10.1089/jpm.2017.0257
          10.1089/jpm.2017.0257
          5863079
          29058504
          21371a45-7b77-4606-95b2-b5c93fde505b
          Copyright 2018, Mary Ann Liebert, Inc.
          History
          : 18 August 2017
          Page count
          Figures: 2, Tables: 3, References: 38, Pages: 7
          Categories
          Original Articles

          Uganda,palliative medicine,palliative care,neoplasms,interdisciplinary communication,culture,Africa

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