“To Speak of Death Is to Invite It”: Provider Perceptions of Palliative Care for Cardiovascular Patients in Western Kenya

“To Speak of Death Is to Invite It”: Provider Perceptions of Palliative Care for Cardiovascular Patients in Western Kenya

Cardiovascular disease (CVD) is the leading cause of death globally and a significant health burden in Kenya. Despite improved outcomes in CVD, palliative care has limited implementation for CVD in low-income and middle-income countries. This may be partly because of providers' perceptions of p...

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Bibliographic Details
Published in:Journal of pain and symptom management Vol. 60; no. 4; pp. 717 - 724
Main Authors: Love, Keith R., Karin, Elizabeth, Morogo, Daniel, Toroitich, Florence, Boit, Juli M., Tarus, Allison, Barasa, Felix A., Goldstein, Nathan E., Koech, Myra, Vedanthan, Rajesh
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-10-2020
Elsevier Limited
Subjects:
Advance directives
Cardiovascular disease
Cardiovascular diseases
Clinical outcomes
Communication
Death & dying
Decision making
End of life decisions
Focus groups
global health
Interviews
Low income groups
Moderators
Palliative care
Perceptions
Poverty
Qualitative research
Quality of life
Saturation
Stigma
symptom management
Kenya
global health
symptom management
Cardiovascular disease
qualitative research
palliative care
cardiovascular disease
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Summary:Cardiovascular disease (CVD) is the leading cause of death globally and a significant health burden in Kenya. Despite improved outcomes in CVD, palliative care has limited implementation for CVD in low-income and middle-income countries. This may be partly because of providers' perceptions of palliative care and end-of-life decision making for patients with CVD. Our goal was to explore providers' perceptions of palliative care for CVD in Western Kenya to inform its implementation. We conducted eight focus group discussions and five key informant interviews. These were conducted by moderators using structured question guides. Qualitative analysis was performed using the constant comparative method. A coding scheme was developed and agreed on by consensus by two investigators, each of whom then independently coded each transcript. Relationships between codes were formulated, and codes were grouped into distinct themes. New codes were iteratively added with successive focus group or interview until thematic saturation was reached. Four major themes emerged to explain the complexities of integrating of palliative care for patients with CVD in Kenya: 1) stigma of discussing death and dying, 2) mismatch between patient and clinician perceptions of disease severity, 3) the effects of poverty on care, and 4) challenges in training and practice environments. All clinicians expressed a need for integrating palliative care for patients with CVD. These results suggest that attainable interventions supported by local providers can help improve CVD care and quality of life for patients living with advanced heart disease in low-resource settings worldwide.
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ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2020.05.003