Massawe Anna A, Isack Manji N, Drury-Smith Heather, Serventi Furaha, Mmbaga Blandina T, Henke Oliver
Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Department of Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Palliat Care Soc Pract. 2025 Sep 7;19:26323524251372661. doi: 10.1177/26323524251372661. eCollection 2025.
Advance care planning (ACP) is not formally implemented in Tanzanian healthcare. While the burden of non-communicable diseases continues to rise, most patients present at advanced stages of illness, highlighting the urgent need for ACP to support preference-based care.
This study aimed to explore advanced cancer patients' experiences and perceptions of ACP at a university teaching hospital in Northern Tanzania. Findings may inform the contextual relevance and acceptability of ACP tools in low-resource settings.
This qualitative study employed individual in-depth interviews with eight patients diagnosed with advanced cancer at Kilimanjaro Christian Medical Centre. Participants received a translated version of the Five Wishes document to read and discuss with their families at home prior to the interviews. A phenomenological approach guided the data collection and analysis. Interviews were conducted in Swahili, transcribed verbatim, translated into English, and thematically analyzed using an inductive coding process by two researchers.
Four key themes emerged: (1) nature of acceptance, (2) challenges to uptake and utilization of ACP, (3) modality and timing of conversations, and (4) strategies for effective integration into clinical care. While initial hesitation was common, participants generally found ACP relevant and valuable for family harmony, future preparation, and quality of life.
Despite limited awareness and sociocultural taboos around death, ACP was viewed as meaningful by patients with advanced illness. Further studies are needed to evaluate culturally appropriate adaptations and implementation strategies for ACP in the Tanzanian context.
坦桑尼亚的医疗保健体系中尚未正式实施预先护理计划（ACP）。随着非传染性疾病负担持续上升，大多数患者在疾病晚期才前来就诊，这凸显了迫切需要ACP来支持基于患者偏好的护理。
本研究旨在探讨坦桑尼亚北部一家大学教学医院中晚期癌症患者对ACP的体验和看法。研究结果可能为低资源环境下ACP工具的背景相关性和可接受性提供参考。
这项定性研究对乞力马扎罗基督教医疗中心的8名被诊断为晚期癌症的患者进行了个人深度访谈。在访谈前，参与者收到了一份翻译后的《五个愿望》文件，以便在家中阅读并与家人讨论。采用现象学方法指导数据收集和分析。访谈用斯瓦希里语进行，逐字记录，翻译成英语，然后由两名研究人员通过归纳编码过程进行主题分析。
出现了四个关键主题：（1）接受的本质，（2）ACP采用和利用的挑战，（3）对话的方式和时机，以及（4）有效融入临床护理的策略。虽然最初的犹豫很常见，但参与者普遍认为ACP与家庭和谐、未来准备和生活质量相关且有价值。
尽管对死亡的认识有限且存在社会文化禁忌，但晚期疾病患者认为ACP是有意义的。需要进一步研究，以评估在坦桑尼亚背景下对ACP进行文化上适当的调整和实施策略。
