Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore.
Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore.
J Pain Symptom Manage. 2022 Oct;64(4):e195-e201. doi: 10.1016/j.jpainsymman.2022.06.001. Epub 2022 Jun 12.
To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia.
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.
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.
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%).
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.
迄今为止，人们对亚洲低收入和中等收入国家（LMICs）的姑息治疗（PC）意识和利用情况知之甚少。
本研究旨在调查亚洲选定 LMIC 中主要医院的晚期癌症患者对 PC 的认识及其预测因素、对 PC 服务的利用情况以及对 PC 利用的感知障碍。
这项横断面研究分析了来自亚洲四个 LMIC 主要医院的 759 名晚期癌症患者的数据（孟加拉国、菲律宾、斯里兰卡和越南）。利用多变量逻辑回归分析了 PC 意识的预测因素。
总体上 PC 意识为 30.8%（n = 234）。接受过高等教育的患者（比值比 [OR] = 1.0；95%置信区间 [CI] = 1.0，1.1）、来自中上或高收入家庭（与低收入家庭相比）（OR = 2.0；CI = 1.2，3.3）、对疾病严重程度有认识（OR = 1.5；CI = 1.0，2.2）和更高的疼痛严重程度（OR = 1.1；CI = 1.0，1.2）的患者对 PC 的意识更高。与那些认为自己非常了解疾病进程的患者相比，那些不确定（OR = 0.5；CI = 0.3，0.8）或不了解（OR = 0.5；CI = 0.3，0.9）的患者对 PC 的意识较低。在有 PC 意识的患者中，PC 使用率为 35.0%（n = 82），在接受医疗保健专业人员推荐 PC 的患者中，PC 使用率为 47.8%（n = 66）（n = 138）。最常提到的 PC 利用障碍是目前正在接受抗癌治疗（n = 43；33.9%）和对 PC 信息了解不足（n = 41；32.3%）。
这些亚洲 LMIC 主要医院中 PC 服务意识较低，这表明该地区可能需要更多努力来提高对 PC 的认识。这些努力应特别针对弱势群体，以缩小 PC 意识差距。
