Palliative care content on cancer center websites.

PURPOSE: Professional guidelines recommend that palliative care begin early in advanced cancer management, yet integration of palliative and cancer care remains suboptimal. Cancer centers may miss opportunities to provide palliative care information online. In this study, we described the palliative care content on cancer center websites. METHODS: We conducted a systematic content analysis of 62 National Cancer Institute- (NCI) designated cancer center websites. We assessed the content of center homepages and analyzed search results using the terms palliative care, supportive care, and hospice. For palliative and supportive care webpages, we assessed services offered and language used to describe care. Two researchers analyzed all websites using a standardized coding manual. Kappa values ranged from 0.78 to 1. RESULTS: NCI-designated cancer center homepages presented information about cancer-directed therapy (61%) more frequently than palliative care (5%). Ten percent of cancer centers had no webpage with palliative care information for patients. Among centers with information for patients, the majority (96%) defined palliative or supportive care, but 30% did not discuss delivery of palliative care alongside curative treatment, and 14% did not mention provision of care early in the disease process. CONCLUSIONS: Cancer center homepages rarely mention palliative care services. While the majority of centers have webpages with palliative care content, they sometimes omit information about early use of care. Improving accessibility of palliative care information and increasing emphasis on early provision of services may improve integration of palliative and cancer care.

Assessment of the face validity of two pain scales in Kenya: a validation study using cognitive interviewing.

BACKGROUND: Patients in sub-Saharan Africa commonly experience pain, which often is un-assessed and undertreated. One hindrance to routine pain assessment in these settings is the lack of a single-item pain rating scale validated for the particular context. The goal of this study was to examine the face validity and cultural acceptability of two single-item pain scales, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), in a population of patients on the medical, surgical, and pediatric wards of Moi Teaching and Referral Hospital in Kenya. METHODS: Swahili versions of the NRS and FPS-R were developed by standard translation and back-translation. Cognitive interviews were performed with 15 patients at Moi Teaching and Referral Hospital in Eldoret, Kenya. Interview transcripts were analyzed on a question-by-question basis to identify major themes revealed through the cognitive interviewing process and to uncover any significant problems participants encountered with understanding and using the pain scales. RESULTS: Cognitive interview analysis demonstrated that participants had good comprehension of both the NRS and the FPS-R and showed rational decision-making processes in choosing their responses. Participants felt that both scales were easy to use. The FPS-R was preferred almost unanimously to the NRS. CONCLUSIONS: The face validity and acceptability of the Swahili versions of the NRS and FPS-R has been demonstrated for use in Kenyan patients. The broader application of these scales should be evaluated and may benefit patients who currently suffer from pain.

Integration of Palliative Care Into Comprehensive Cancer Treatment at Moi Teaching and Referral Hospital in Western Kenya.

PURPOSE: The prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital. METHODS: This is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to identify current challenges and opportunities for program improvement. RESULTS: This study documents the implementation of a palliative care service line in Eldoret, Kenya. Barriers to providing optimal palliative cancer care include distance to pharmacies that stock opioids, limited selection of opioid preparations, education of health care workers in palliative care, access to palliative chemoradiation, and limited availability of outpatient and inpatient hospice services. CONCLUSION: Palliative care services in Eldoret, Kenya, have become a key component of its comprehensive cancer treatment program.

Prevalence and correlates of pain and pain treatment in a western Kenya referral hospital.

BACKGROUND: Pain is often inadequately evaluated and treated in sub-Saharan Africa (SSA). OBJECTIVE: We sought to assess pain levels and pain treatment in 400 hospitalized patients at a national referral hospital in western Kenya, and to identify factors associated with pain and pain treatment. DESIGN: Using face-validated Kiswahili versions of two single-item pain assessment tools, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), we determined patients' pain levels. Additional data collected included patient demographics, prescribed analgesics, and administered analgesics. We calculated mean pain ratings and pain management index (PMI) scores. RESULTS: Averaged between the NRS and FPS-R, 80.5% of patients endorsed a nonzero level of pain and 30% of patients reported moderate to severe pain. Older patients, patients with HIV, and cancer patients had higher pain ratings. Sixty-six percent of patients had been prescribed analgesics at some point during their hospitalization, the majority of which were nonopioids. A majority of patients (66%) had undertreated pain (negative scores on the PMI). CONCLUSION: This study shows that hospitalized patients in Kenya are experiencing pain and that this pain is often undertreated.

Financial impact of palliative care consultation in a public hospital.

BACKGROUND: Palliative care programs assist with prognostication, symptom control, and communication with patient and family. Hospitals often require financial justification for new programs Objective: Study the financial impact of the palliative care consultation (PCc) service in a public hospital. SETTING/SUBJECTS: From January to December 2005, 258 deaths occurred on the medicine service. Of those deceased patients, 116 were studied. DESIGN: Inclusion criteria were 50 or more years of age, length of stay (LOS) 3 days or more, admission to an internal medicine service, and death during that hospitalization. MEASUREMENTS: Charges, diagnosis-related groups (DRGs), DRG weights, and demographic variables were examined. RESULTS: Of the 116 deceased patients studied, 61 patients received a PCc, while 55 did not. Most patients had Medicare or Medicaid (82.8%). Both groups were similar in terms of demographic characteristics. Average LOS was 14.4 days for patients with a PCc versus 12.2 days for those without (p = 0.57). Median charges for the group without a PCc were $42,731, versus a median of $35,824 for those with a PCc. There was no significant variation of DRG weights within the same DRG. DRG weight was significantly positively correlated with charges. Both PCc and DRG weight were significant predictors of charges, with 36% of charges variability explained by PCc and DRG weight. CONCLUSIONS: PCc significantly reduced charges in adult patients who died during their last hospitalization, even though the average LOS was higher for those who received a PCc versus those who did not.