Mah Kenneth, Powell Richard A, Malfitano Carmine, Gikaara Nancy, Chalklin Lesley, Hales Sarah, Rydall Anne, Zimmermann Camilla, Mwangi-Powell Faith N, Rodin Gary
Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
MWAPO Health Development Group, Nairobi, Kenya.
J Glob Oncol. 2019 Jun;5:1-16. doi: 10.1200/JGO.18.00257.
A culturally appropriate, patient-centered measure of the quality of dying and death is needed to advance palliative care in Africa. We therefore evaluated the Quality of Dying and Death Questionnaire (QODD) in a Kenyan hospice sample and compared item ratings with those from a Canadian advanced-cancer sample.
Caregivers of deceased patients from three Kenyan hospices completed the QODD. Their QODD item ratings were compared with those from 602 caregivers of deceased patients with advanced cancer in Ontario, Canada, and were correlated with overall quality of dying and death ratings.
Compared with the Ontario sample, outcomes in the Kenyan sample (N = 127; mean age, 48.21 years; standard deviation, 13.57 years) were worse on 14 QODD concerns and on overall quality of dying and death ( values ≤ .001) but better on five concerns, including interpersonal and religious/spiritual concerns ( values ≤ .005). Overall quality of dying was associated with better patient experiences with Symptoms and Personal Care, interpersonal, and religious/spiritual concerns ( values < .01). Preparation for Death, Treatment Preferences, and Moment of Death items showed the most omitted ratings.
The quality of dying and death in Kenya is worse than in a setting with greater PC access, except in interpersonal and religious/spiritual domains. Cultural differences in perceptions of a good death and the acceptability of death-related discussions may affect ratings on the QODD. This measure requires revision and validation for use in African settings, but evidence from such patient-centered assessment tools can advance palliative care in this region.
为推动非洲的姑息治疗，需要一种符合文化背景且以患者为中心的死亡质量衡量标准。因此，我们在肯尼亚一家临终关怀机构的样本中对死亡质量问卷（QODD）进行了评估，并将各项目评分与加拿大晚期癌症样本的评分进行了比较。
来自肯尼亚三家临终关怀机构的已故患者的照料者完成了QODD问卷。他们的QODD项目评分与加拿大安大略省602名晚期癌症已故患者的照料者的评分进行了比较，并与死亡总体质量评分相关联。
与安大略省的样本相比，肯尼亚样本（N = 127；平均年龄48.21岁；标准差13.57岁）在14个QODD关注方面以及死亡总体质量上表现更差（P值≤.001），但在包括人际关系和宗教/精神层面等5个关注方面表现更好（P值≤.005）。死亡总体质量与患者在症状和个人护理、人际关系以及宗教/精神层面的更好体验相关（P值<.01）。死亡准备、治疗偏好和死亡时刻项目的评分遗漏最多。
肯尼亚的死亡质量比在更容易获得姑息治疗的环境中更差，人际关系和宗教/精神领域除外。对善终的认知以及与死亡相关讨论的可接受性方面的文化差异可能会影响QODD的评分。该衡量标准需要修订和验证以用于非洲环境，但这种以患者为中心的评估工具提供的证据可以推动该地区的姑息治疗。
