The assessment of the palliative care needs of patients attending the Mbabane government hospital oncology unit

Msane, Siphile

The assessment of the palliative care needs of patients attending the Mbabane government hospital oncology unit

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Background: Palliative care aims to provide holistic care and improve the quality of life of patients and their families faced with life-threatening conditions. Across the world, access to palliative care is limited, particularly in low- and middle-income countries like Eswatini. Eswatini is a small predominantly rural country that faces poverty and uneven distribution of resources - factors that contribute to the challenges in delivering effective palliative care. This study explores the palliative care needs of patients at the Mbabane Government Hospital's oncology unit, as the palliative care needs of these patients are largely unknown(1). Aim: This study aimed to assess the palliative care needs of oncology patients at the Mbabane Government Hospital Oncology Unit. Objectives: 1. To describe the prevalence of pain and other symptoms amongst cancer patients at the Mbabane Government Hospital oncology unit. 2. To describe the quality of life amongst oncology patients at Mbabane Government Hospital. 3. To determine the information needs of the cancer patients. Methods: A cross-sectional descriptive study was conducted at the MGH oncology unit. The study population was the patients attending the MGH oncology unit and recruitment was inclusive of all new and old patients. However, participants younger than 18, were excluded, and those who didn't have the mental capacity to make decisions including the frail patients. The study applied nonprobability convenience sampling by inviting consecutive patients over a 3-month period. A research assistant was recruited to avoid coercion as the researcher is also one of the unit's treating doctors. The research assistant's role was to provide information about the study, obtain consent, and conduct the interviews. The data collection tool was a questionnaire that included demographic and clinical variables and the APCA IPOS, a well-established tool measuring care outcomes with demonstrable validity and reliability in African settings. Results: This study examined the prevalence of various symptoms and psychosocial experiences among 128 cancer patients and 29 family members. Of the 128, 98 (76.5%) were female, 30 (23.4%) were male. The most prevalent cancer was cervical cancer 62 (48.4%), breast cancer 22 (17.2%), and prostate cancer 11 (10.1%) were also prevalent in this study population. Seventy-nine (61.7%) reported pain as the most prevalent symptom. Weakness was the second most common symptom, with 46 (35.9%) participants reporting having varying degrees of weakness. Forty-one (32%) experienced constipation over the past 3 days, and forty (31.25%) experienced poor appetite. Regarding psychosocial experiences, 58 (45.3%) reported not being worried about their condition, but 70 (54.7%) had varying degrees of worry. Twenty-eight (21.9%) were able to share their feelings all the time, while 24 (18.8%) weren't able to share their feelings at all. Eighty-eight (69%) found life worthwhile all the time, while 2 (1.5%) didn't find life worthwhile at all. Forty-three (33.6%) had peace all the time, while 13 (10.2%) reported no peace. Forty-two (32.8%) had received as much information as they wanted; however, 54 (42.2%) of the 128 reported not receiving any information. The median total IPOS was 16 (IQR: 13 with Q1=10, Q3=21). The minimum total IPOS score was 4. and the maximum was 50. Thirty (23.4%) had a total score between 0-9; 57 (44.5%) had a total score between 10-19; and five (3.9%) patients scored between 40-49, indicating an inferior palliative care outcome. Twenty-nine family participants participated in this study. Among the family participants, 8 (27.6%) reported receiving as much information as they wanted and, 5 (17.2%) reported not having any information. Seventeen (58.2%) reported being very confident and 3 (10.3%) reported not having confidence at all. However, 16 (55.2%) reported not being worried about the patient's condition, while two (7%) reported being worried all the time and 4 (14%) were worried occasionally. Conclusion: This study indicates that the cancer patients at the MGH oncology unit have unmet needs, comparable to findings from other African studies, especially concerning physical, psychological, and medical communication/information needs. In the case of the Mbabane Government Hospital oncology unit, the evidence shows that a review is required of the palliative care provided, as the current approach does not address all patient needs. The APCA IPOS tool may be a suitable instrument to include in routine patient care in the oncology unit at MGH to assess the palliative care needs of patients, and to provide appropriate care to improve the patient's quality of life. By optimizing the palliative care provided, the oncology unit can deliver comprehensive support that caters to the needs of patients and their caregivers, an approach that is crucial to patient care. The integration of palliative care in oncology is endorsed by international organizations such as the World Health Organization.

Keywords

palliative care

oncology

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