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Background: Cancer incidence in the world is predicted to increase in the next decade. While progress has been in diagnosis and treatment, much still remains to be done to improve cancer pain therapy, mainly in underserved communities in low-income countries. Objective: To determine knowledge, beliefs, and barriers regarding pain management in both high- and low-income countries (according to the WHO classification); and to learn about ways to improve the current state of affairs. Design: Descriptive survey. Setting/Subjects: Fifty-six countries worldwide; convenience sample of 1639 consisted of 36.8% physicians; 45.1% nurses, and 4.5% pharmacists employed in varied settings. Results: Improved pain management services are key elements. Top barriers include religion factors, lack of appropriate education and training at all levels, nonadherence to guidelines, patients' reluctance to report on pains, over regulation associated with prescribing and access to opioid analgesics, fear of addiction to opioids, and lack of discussions around prognosis and treatment planning. Conclusion: The majority of patients with cancer in low-income countries are undertreated for their pain. Promoting cancer pain accredited program of training and education on pain management for physicians and nurses is crucial, as well as advocating policymakers and the public at large. Keywords: cancer; global; management; opioids; pain.

World Health Organization (WHO) (The protocol for the WHO study on the effectiveness of community-based programmes for NCD prevention and control (No. NMH/NPH/NCP/03.09). World Health Organization, Geneva, 2003) predicts that by 2030, non-communicable diseases will be the leading cause of death in Sub-Saharan Africa. In 2012, there were 645,000 new cancer cases and 456,000 cancer-related deaths in Africa. The need for palliative care in the region is expected to keep increasing. Palliative care is a relatively new field in Africa, and only about 5% of patients who need it can access it. Governments are investing more in cure and prevention, and very few have integrated palliative care into mainstream policies or created stand-alone policies.

Context Palliative care triggers have been used in the intensive care unit (ICU) setting, usually in high-income countries, to identify patients who may benefit from palliative care consults. The utility and benefits of palliative care triggers in the ICU have not been previously studied in sub-Saharan Africa. Objectives Our objectives were to determine the prevalence of ICU admissions in those who met at least one palliative care trigger and whether a palliative care consult influenced the length of ICU stay and time to change of goals order. Methods We conducted a prospective observational cohort study within our ICU at the Aga Khan University Hospital, Nairobi, between December 2019 and August 2020. Data including initiation of a palliative care consult, length of ICU stay, mortality, and time to change of goals order were collected. Results During our study period, 72 of 159 (45.9%) patients met at least one palliative care trigger point. Of the patients who met the palliative care triggers, only 29.2% received a palliative care consult. Patients who received palliative care consults had higher rates of change of goals orders signed (52.3%) vs. those who did not (P = 0.009). There was no statistically significant difference between the consult and nonconsult groups in regard to length of ICU stay, time to change of goals order, and mortality. Conclusion A trigger-based model, geared to the needs of the specific ICU, may be one way of improving integration of palliative care into the ICU, especially in sub-Saharan Africa.

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and a major cause of mortality globally. Atypical presentation of HCC can present a diagnostic challenge. We, therefore, present a rare case of hepatocellular carcinoma fungating through the anterior abdominal wall with concomitant lung and brain metastases in a young patient with non-cirrhotic liver but positive chronic hepatitis B serology.

Introduction: Palliative care aims at ameliorating patients and families suffering when they are faced with life-limiting illnesses. It involves symptoms management as well as psychosocial, spiritual support. As such, proper communication between clinicians taking care of the patient is an important aspect of this care. Studies have shown that errors in communication are common and relevant in palliative care as they negatively impact on the quality of care provided. The service at Aga Khan University Hospital, Nairobi (AKUHN) provides both in and out patient consult services. Primary physicians to patients consult the palliative care team via telephone models as well as face to face talks. There is a lot of literature regarding patient/family member consultation with a doctor but little has been done on understanding the efficacy of doctor to doctor telephone discussion on a patient being referred from one service provider to another. Objective: The aim was to assess the adequacy of information regarding the patient given in telephone consults versus face to face consults during the referral process. Methodology: This was a cross-sectional study. 60 consults to the palliative care team were assessed, these were consults received over a period of 4 months; 36 were telephone consults and the rest face to face. The information was assessed for inclusion of the following details: I) name II) age, III) gender, IV) longevity of illness, V) ward/clinic location, VI) Patient's diagnosis, VII) reasons for referral, VIII) current treatments, IX) patient's knowledge of their diagnosis and prognosis, X) family's knowledge of diagnosis and prognosis and XI) patient's and family's knowledge of referral to palliative care. Results: Overall, there are more missed characteristics of a patient in a telephone consult compared to a face to face consult. The most missed characteristics in both types of consults were name, patient and family knowledge of referral, patients' and families knowledge of diagnosis. Conclusion: It is evident that a telephone consult is less informative than a face to face consult. It is therefore important to have a face to face discussion on a patient after telephone consultation. It is also evident from these findings that doctors are still poor in the aspects of communicating with patients, their families and also among themselves and more need to be done to improve this.

Palliative care is an interdisciplinary care to relieve suffering and improve quality of life for patients and their families. The development of effective combination antiretroviral therapy has transformed HIV from a terminal to a chronic condition, with patients living longer but also experiencing more extensive symptoms that significantly impact quality of life. As a result, the role of palliative care has evolved to ameliorating distressing symptoms including pain while at the same time offering psychosocial and spiritual support for patients and families and preparing them for a dignified death. This chapter discusses some of the challenges and symptoms that patients and families encounter as they face this life-limiting disease.

Patients and caregivers in palliative care experience multidimensional pain. In current practice, information about a cancer patient progress is known when they visit a clinic or make a distress call when their conditions worsen. This strategy is not efficient for systematic monitoring of symptoms, which is key in improving palliative care. Mobile phones have helped to transform healthcare through diagnosis, health education and symptoms management of chronic illnesses. In this study, a mobile phone assessment tool was implemented at an outpatient palliative care clinic for cancer patients in Aga Khan University Hospital, Nairobi. The usefulness of the mobile phone application was examined. In the initial interview with a cohort of 19 patients and caregivers, 15 were eligible for the study. Patients and caregivers used the application to report their symptoms and needs at an interval of one week. Participatory action design was used whereas data collection was achieved through non-structured interviews. Findings from the study were organized into three themes: enhanced communication, improved assessment of total cancer pain and advocacy tool. This study illustrates that utilization of mobile phone applications can enhance palliative care by improving monitoring of symptoms and strengthening patient-provider communication.

6545Background: There is limited access to quality Palliative Care (PC) for advanced cancer patients being treated in Sub Saharan Africa due to limited PC knowledge among health care providers in t...

255 Background: Cancer has become a significant public health problem in Africa but still most diagnoses are made late, Sitas et al (2006). The need for palliative care is significant due to the late contact with health care providers and the many symptoms they present with. No study has been undertaken to assess symptomatology for these patients in Africa. Objective: To study the prevalence of symptoms in patients with cancer in an African setting. Methods: Symptom studies from records of patients with cancer referred to the Palliative Care Services at the Aga Khan University Hospital, Nairobi in 6 months. Symptoms charted on Edmonton Symptom Assessment Scale. Results: 42 patients were referred to the service in this period. All the patients reported > 3 symptoms which cut across the physical, social, psychological and spiritual concerns. The most common symptoms were pain in the physical dimension (90%) as reported by the patient. Fatigue was reported by (93%).Family wellbeing was the main worry in psychological dimension (95%). 94 % reported social disconnect due to the diagnosis, job losses and huge cost of health care. 96% suffered from the existential question of why me and worry about the future. Conclusions: Cancer has become a major burden to patients, families, societies and nations in Africa. Patients suffering from this illness experience a myriad of symptoms which require holistic approach to care. Social wellbeing remains a major concern for patients with cancer in Africa.

Background An advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on life-sustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of terminally ill patients with AD and to identify the factors that influence the completion of AD amongst terminally ill patients at a tertiary hospital in Kenya. Methods The study was a retrospective survey. All available records of terminally ill patients seen at Aga Khan University Hospital, Nairobi, between July 2010 and December 2015, and that met the inclusion criteria were included in the study. Results In total, 216 records of terminally ill patients were analyzed: 89 records were of patients that had AD and 127 records were of patients that did not have AD. The proportion of terminally ill patients that had completed AD was 41.2%. The factors that were associated with the completion of AD on bivariate analysis were history of ICU admission, history of endotracheal intubation, functional status of the patient, the medical specialty taking care of the patient, patient’s caregiver discussing the AD with the patient, and a palliative specialist review. On multivariate regression analysis, discussion of AD with a caregiver and patient’s functional impairment were the factors with statistically significant association with completion of AD. Conclusions The proportion of terminally ill patients that had AD in their medical records was significant. However, most terminally ill patients did not have AD. Our data, perhaps the first on the subject in East Africa, suggest that most of the factors associated with AD completion mirrored those seen in other regions of the world. Discussion between patient and their physician and patient’s functional impairment were the factors independently associated with completion of AD. Therefore, physicians need to be aware of the importance of discussions of AD with their patients.