Assessing the palliative care needs of end stage kidney disease patients in a tertiary hospital in Nigeria

Adebayo, Adetayo Jolade

Assessing the palliative care needs of end stage kidney disease patients in a tertiary hospital in Nigeria

Master Thesis

2022

Abstract

Background: Worldwide, end-stage kidney disease (ESKD) is associated with high morbidity and mortality. Currently, the incidence of ESKD in Nigeria is about 1.6% -12.4% and is higher amongst 25-45 year-olds, implying that ESKD indirectly affects the economic productivity of the nation negatively. ESKD is a condition that may progresses rapidly from a chronic to a terminal phase and is responsible for about 2-3% of all hospital admission worldwide while in Nigeria the proportion of admissions is as high as 10%. This high symptom and disease burden of ESKD warrants implementation of a palliative care program that is able to assess and manage the needs of patients with this condition and to support their families. Methods: A descriptive study was undertaken to assess the palliative care needs of patients. A random sample of 110 ESKD patients attending University College Hospital (UCH) Ibadan were interviewed using published standardized and validated questionnaire over a period of 3-months. The questionnaire was a combination of the Integrated Palliative Outcome Scale-Renal Patient Version (IPOS-R) and Hope Spiritual Assessment Tool (HOPE). The socio-demographic characteristics comprising of gender, age, place of residence and knowledge of palliative care were determined. IPOS-R was used to explore the patients' symptom-burden, psychological and social palliative care needs and quality of life while the HOPE was used to explore patients' spiritual needs. Ethical approval was obtained from the relevant organizations. Data was analyzed using the IBM SPSS version 23.0. Results: More than half of the participants (57%) were female, 92% had co-morbidities, 86% had formal education, 60% were self-employed and their median age was 43.5years. Half (51%) reported experiencing severe symptoms and poor quality of life. More than half (50%) of the patients complained of shortness of breath, pain, general body malaise, sore mouth, restless with more than 80% reporting nausea, poor appetite, difficulty in sleeping and weakness. Fifty-three percent reported experiencing anxiety most of the time and reported that their families and friends were worrying about them. The majority (98%) said their source of hope was God. Most patients (93%) said they were not aware of palliative care medicine. Conclusion: There is a huge need for palliative care for patients with ESKD in Nigeria. This study has developed a framework that can be used by a palliative care team, in collaboration with nephrologists, to provide a person-centered care for these patients and their families.