Brief Report
Awareness and Utilization of Palliative Care Among Advanced Cancer Patients in Asia

https://doi.org/10.1016/j.jpainsymman.2022.06.001Get rights and content

Abstract

Context

To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia.

Objectives

This study aimed to investigate PC awareness and its predictors, utilization of PC services, and perceived utilization barriers among advanced cancer patients from select hospitals in Asian LMICs.

Methods

This cross-sectional study analyzed data of 759 advanced cancer patients at major hospitals of four LMICs in Asia (i.e., Bangladesh, Philippines, Sri Lanka, and Vietnam). The predictors of PC awareness were investigated using multivariable logistic regression.

Results

Overall PC awareness was 30.8% (n = 234). Patients with higher education (OR = 1.0; CI = 1.0,1.1), from upper-middle or high-income households (compared to low-income) (OR = 2.0; CI = 1.2,3.3), awareness of disease severity (OR = 1.5; CI = 1.0,2.2), and higher pain severity (OR = 1.1; CI = 1.0,1.2) had higher odds of PC awareness. Compared to patients who perceived themselves as being very informed about disease trajectory, those who were unsure (OR = 0.5; CI = 0.3,0.8) or uninformed (OR = 0.5; CI = 0.3,0.9) had lower odds of PC awareness. The PC utilization rate was 35.0% (n = 82) among those with PC awareness, and 47.8% (n = 66) among patients recommended PC by a healthcare professional (n = 138). The most cited PC utilization barriers were currently receiving anti-cancer treatment (n = 43; 33.9%), and having insufficient information about PC (n = 41; 32.3%).

Conclusion

The low awareness of PC services in these major hospitals in Asian LMICs highlights that more effort may be required to promote the awareness of PC in this region. The efforts should especially focus on those from disadvantaged groups to reduce the gap in PC awareness.

Section snippets

Key Message

The low awareness and utilization of palliative care among participants highlights that more effort may be required to promote palliative care in this region. The efforts should especially focus on those from disadvantaged groups to reduce the gap in PC awareness.

Survey Setting and Participants

This study is part of a multi-country cross-sectional survey of advanced cancer patients titled “Asian Patient Perspectives Regarding Oncology Awareness, Care and Health (APPROACH).”19 The present study analyzed data of patients seeking treatment in four institutions across four LMICs in Asia – Vietnam (Hue Central Hospital), Philippines (The Medical City), Bangladesh (Bangabandhu Sheikh Mujib Medical University), and Sri Lanka (National Cancer Institute Maharagama). These hospitals are among

Patient Characteristics

Study patients were aged 53.6 ± 13.4 years with 10.4 ± 4.9 years of education (Table 1). There were slightly fewer females (n = 370; 48.8%) than males. Majority of the patients were married (n = 624; 82.2%) and affiliated with a religion (n = 653; 86.0%). About half of the patients (n = 396; 52.2%) rated their household economic status as lower middle-income class. About a quarter (n = 215; 28.3%) reported their household economic status as low-income class. The top three cancers were

Discussion

We found that only about one-third of the advanced cancer patients in our sample were aware of PC. We also found that less than half of the patients were aware that their cancer was in the advanced stage and only about 10% were aware that their cancer is not curable. Since the majority of the advanced cancer patients in Asia are likely to be in need of pain and symptom management and psychosocial support9, the low awareness of PC services and understanding of the disease among advanced cancer

Data Sharing

De-identified participant data will be available through reasonable request to the corresponding author.

Disclosure

This work was supported by the Lien Centre for Palliative Care. The authors declare that they have no competing interests.

Acknowledgments

We would like to thank the study patients who participated in this study.

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    © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.