Otom Lavender, Oyiro Peter, Ogola Elijah
Jaramogi Oginga Odinga Teaching and Referral Hospital, PO Box 849-40100, Kisumu, Kenya.
https://orcid.org/0009-0003-4105-906.
Ecancermedicalscience. 2025 Jun 12;19:1926. doi: 10.3332/ecancer.2025.1926. eCollection 2025.
Advance care planning (ACP) is relevant in the care of cancer patients. Insight into the current practice of ACP can identify high-priority areas to direct interventions aimed at improving the process.
To assess the practice of ACP among ambulatory cancer patients at a Kenyan hospital.
A descriptive cross-sectional survey was conducted at the ambulatory oncology clinic at a tertiary referral hospital. We recruited 387 study participants through consecutive sampling among heterogenous cancer patients. An interviewer-administered questionnaire was used to collect data, which was analysed by SPSS version 25 and through multivariable logistical regression.
Among 387 participants, 78.55% were females. The uptake of advance directives was low; only 27.13% of participants had appointed surrogate decision makers, while 1.5% had living wills. Few had discussed end-of-life wishes with family (28.68%) and doctors (19.63%). Only 27.39% had discussed life expectancy with a doctor. Among those who had not participated in ACP, most were willing to discuss life expectancy (71.9%); discuss end-of-life wishes with family (81.2%) and doctors (85.1%); complete advance directives (68%) and appoint surrogate decision makers (75.9%) in the next 1 month. Doctors were most preferred to initiate ACP discussions. Factors that positively correlated with uptake of advanced directives (ADs) included - ECOG status, discussion with family and with doctors.
The uptake of ADs among ambulatory cancer patients was low; additionally, self-reported participation in ACP was low. Our study highlights the need for widespread education initiatives and standardisation of the ACP process.
There is a need for further studies and strategies to improve the participation in ACP and hence the quality of life among patients with malignancies in Kenya.
预立医疗计划（ACP）在癌症患者护理中具有重要意义。深入了解ACP的当前实践情况可以确定高优先级领域，以指导旨在改善该过程的干预措施。
评估肯尼亚一家医院门诊癌症患者的ACP实践情况。
在一家三级转诊医院的门诊肿瘤诊所进行了一项描述性横断面调查。我们通过在不同类型癌症患者中连续抽样的方式招募了387名研究参与者。使用由访谈员实施的问卷收集数据，并通过SPSS 25版本进行分析以及多变量逻辑回归分析。
在387名参与者中，78.55%为女性。预立医嘱的采用率较低；只有27.13%的参与者指定了替代决策者，而1.5%的参与者有生前预嘱。很少有人与家人（28.68%）和医生（19.63%）讨论过临终愿望。只有27.39%的人与医生讨论过预期寿命。在未参与ACP的人中，大多数愿意在接下来的1个月内讨论预期寿命（71.9%）；与家人（81.2%）和医生（85.1%）讨论临终愿望；完成预立医嘱（68%）并指定替代决策者（75.9%）。医生最适合发起ACP讨论。与预立医嘱（ADs）采用呈正相关的因素包括——东部肿瘤协作组（ECOG）状态、与家人及与医生的讨论。
门诊癌症患者中ADs的采用率较低；此外，自我报告的ACP参与率也较低。我们的研究强调了开展广泛教育举措和规范ACP流程的必要性。
需要进一步开展研究并制定策略，以提高肯尼亚恶性肿瘤患者对ACP的参与度，从而改善其生活质量。
