Depressive Symptoms and Palliative Care Concerns Among Patients With Non-communicable Diseases in Two Southern African Countries |
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| Affiliation: | 1. African Palliative Care Association, Kampala Uganda and King''s College London, Cicely Saunders Institute of Palliative Care (E.N.), Policy & Rehabilitation, London, United Kingdom;2. Department of Primary Care and Public Health, School of Public Health (R.A.P.), Faculty of Medicine, Imperial College London, London, England;3. Auckland University of Technology (S.T.), Auckland, New Zealand;4. Department of Palliative Medicine, University Hospital Bonn (L.R.), Bonn, Germany;5. School of Allied Health Sciences, University of Namibia (R.F.), Windhoek, Namibia;6. School of Public Health, University of Namibia (D.H.), Windhoek, Namibia;7. Lighthouse Trust, Kamuzu Central Hospital (B.M.M.), Lilongwe, Malawi;8. Institute of Hospice and Palliative Care in Africa, Hospice Africa Uganda (W.A.), Kampala, Uganda;9. Palliative Care Association of Malawi (L.T.), Blantyre, Malawi;10. Formerly of Ministry of Health (I.K.), Malawi;11. African Palliative Care Association (E.B.K.L.), Kampala, Uganda;12. Girls Not Brides (F.N.M.P.), London, England;13. Florence Nightingale Faculty of Nursing Midwifery and Palliative Care (R.H.), Cicely Saunders Institute, King''s College London, London, United Kingdom;1. Brookdale Department of Geriatrics and Palliative Medicine (J.L.F., L.P.G., C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA;2. Section of Palliative Care and Medical Ethics (R.M.A.), University of Pittsburgh, Pittsburgh, Pennsylvania, USAS;3. Geriatric Research (L.P.G.), Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, New York, USA;4. Division of Hematology and Medical Oncology (C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA;1. Department of Integrated Traditional Chinese and Western Medicine (L.Z., N.L.), West China Hospital, Sichuan University, Chengdu, Sichuan, China;2. Sichuan Second Chinese Medicine Hospital (Y.L., D.X., Y.D.), Chengdu, Sichuan, China;3. Chengdu University of Traditional Chinese Medicine (X.X., Y.S.), Chengdu, Sichuan, China;1. VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA;2. Department of Pediatrics (M.S.W.), University of Nebraska Medical Center, Omaha, Nebraska, USA;3. Departments of Psychiatry and Internal Medicine (C.M.A.G.), Ethics Education, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA;1. Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA;2. Department of Medicine (D.C.), Duke University, Durham, North Carolina, USA |
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| Abstract: | ContextNon-communicable diseases (NCDs), associated with health-related suffering, can benefit from palliative care in resource-limited settings, where over four-fifths of these deaths occur.ObjectiveTo measure the prevalence of depressive symptoms, palliative care-related concerns, physical and other psychological symptoms among adult patients with NCDs in Malawi and Namibia.MethodsThis multi-center, cross-sectional study consecutively recruited outpatients from four tertiary referral hospitals. Stepwise regression analysis was used to assess factors associated with physical and psychological symptom burden.ResultsAmong 457 participants, primary diagnosis was cancer (n=147, 32%); cardiovascular disease (CVD) (n=130, 28%), chronic respiratory disease (CRESD) (n=73, 16%) or diabetes (n=107, 23%). Over half were female (58.9%; n=269), mean age was 48 (SD=15.7). Clinically significant psychological distress was identified among cancer (57.2%), diabetes (57.0%), CRESD (45.2%) and CVD patients (43.1%), with criterion for major depression symptoms met for cancer (42.9%), diabetes (39.2%), CVD (30.0%) and CRESD (28.8%). Most severe palliative care concerns were: first sharing feelings (i.e., not at all/not very often), reported by CVD (28%), CRESD (23%), cancer (22%) and diabetes (21%) patients; second help and advice (i.e., none/very little), among cancer (28%), CVD (26%), diabetes (22%), and CRESD (16%) patients. High prevalence of moderate-to-severe pain was reported (cancer 54%, CVD 41%, CRESD 38%, diabetes 38%). Functional status, age, and presence of comorbidities were associated with physical and psychological symptom distress.ConclusionGiven the high burden of physical and psychosocial symptoms and symptom distress, the findings highlight the need for integrated person-centered palliative care for NCDs to optimize care outcomes. |
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