Knowledge, attitude, practice, and barriers to service delivery of paediatric palliative care amongst health care practitioners in Kenya – A mixed methods observational study

Abstract

Background: Approximately 40 million people need palliative care annually, 98% living in low-and-middle income countries and 50%  being paediatrics. The aim of this study was to evaluate Health Care Practitioners (HCPs) knowledge, attitudes, and practices on  Paediatric Palliative Care (PPC).

Methods: A retrospective cross-sectional study (March-August 2020) was carried out at Kenyatta National  Hospital (paediatric medical and surgical units). The sample size of HCPs was determined using a multistage stratified sampling technique distributed proportionately across residents and nurses. Quantitative data collected using self-administered validated  questionnaires, Palliative Care Quiz for Nursing (PCQN) and Frommelt Attitude Toward Care of the Dying (FATCOD), were reported as  adequate for scores >75% and >50% in the PCQN and FATCOD respectively. Multivariate analysis was carried out to compare independent  and outcome variables. Qualitative data was collected using a topic guide for HCPs by means of Focused Group Discussions  and Key Informant Interviews. Ethical consent was obtained from the UoN-KNH Ethics research committee and informed  consent from all participants.

Results: From the 233 participants, 40(17.2%) had good knowledge, 97(41.6%) had good practice on PPC.  Residents had a 35% likelihood of having poor practice of PPC. Main barriers to PPC service delivery included deficient knowledge, stigma,  bureaucracy, poor and late referral processes, and staff shortages.

Conclusion: The HCPs had poor knowledge and practice, but  their attitude towards PPC was favourable. The recommendations are to expand the human resources, create sustainable programs that  prioritize community outreach and public education aiming at demystifying paediatric palliative care in Kenya.