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End of life communication among cancer patients in low- and middle-income countries, perspectives of the patient, family and healthcare professionals: A qualitative systematic review

Joint Event on Breast Pathology & Cancer & Gynecology and Obstetrics Pathology & Palliativecare & Gerontology

June 28-29, 2019 | Oslo, Norway

Justina Yevu Johnson


Posters & Accepted Abstracts: RRJMHS


Introduction: Palliative care and end of life communication is an important component of quality care at the end-of-life. Though there is a general agreement that end of life communication among patients, families, and healthcare professionals is key in quality end of life care, discussion about end-of-life is limited in low- and middle-income countries.

Objective: The review was to determine what factors influenced end of life communication among patients, family caregivers and healthcare providers in low- and middle-income countries.

Method: Systematic search of six databases was conducted, including CINAHL, Ovid, Scopus, Medline, PubMed, and Google Scholar. Inclusion criteria was primary published qualitative studies in developing countries about end of life communication.

Results: Out of the100 articles initially identif ied only 5 met the inclusion criteria after using country specif ic names as a limiter due to the dearth of research on the topic in developing countries. Of the f ive articles included in the review, three were from Africa (Ethiopia, Tanzania, and Kenya), and two from South Asia (Bangladesh and India).

Synthesis of Evidence: The review generated three main themes; antecedents to end of life communication described the struggles to engage in end of life communication that arises when there is the diagnosis of life limiting illness; decision making was seen to be the sole prerogative of the family to the exclusion of the patient; disclosure of diagnosis was surrounded with controversy of healthcare providers lack of knowledge on disclosure and family’s stance on protecting the patient from the psychological stress of the diagnosis.

Conclusion: Culture was found to have an overarching influence on end of life communication in lowand middle-income countries. Hence, an all-inclusive understanding of end of life communication care in a cultural context is essential, especially in low- and middle-income countries where end of life care is gaining a lot of attention. Central to end of life communication is the availability of culturally competent healthcare provider with adequate knowledge on who is ill enough to receive palliative care, how to communicate diagnosis, the limits of the responsibilities of family caregivers.