| dc.description.abstract | Cancer morbidity and mortality is rising more rapidly in the low and middle income countries, where the infrastructure for diagnosis and care is extremely limited compared to the developed countries. Cancer patients experience a wide range of physical and psychosocial effects associated with the disease and its treatment, but these are still poorly understood. Palliative care in Kenya is still emerging and considerably constrained. Its impact on individuals’ wellbeing is recognized but is still understudied. Quality of life (QOL) assessments are frequently used to identify not only related palliative care needs, but also evaluate services provided to the patient. This study aimed to determine the QOL scores and underlying dimensions among palliative care patients in Kisii Teaching and Referral Hospital. Specifically, it determined QOL scores among palliative cancer care patients, association between socio-demographic factors and QOL scores, association between clinical characteristics and QOL and dimensions underlying and the pathways through which social-demographic factors and clinical factors influences QOL. Using a descriptive cross-sectional research design, 120 palliative care cancer patients were surveyed using the Missoula Vitas Quality of Life Index (MVQOL-I). Variable characteristics were summarized descriptively. Mean QOL were estimated for each sub-scale. The association between social-demographic factors and clinical characteristic with QOL was analyzed using chi-square. Confirmatory Factor Analysis (CFA) was used to test how well the observed variables were related to socio-demographic, clinical and quality of life measures. Structural Equation Model (SEM) was used to portray relations among observed and latent variables in theoretical models, enabling to quantitatively test research hypothesis concerning these relationships. Of 120 participants, females comprised 63%; modal age-group was 45-54(30%; p=<0.001); 66% had post-primary level education (p= 0.030). Cervical and breast cancers among females and prostate cancer among males were most prevalent, especially among those25 years; leukemia was reported only among <25-year-olds (p=<0.001). At least 63% (p= <0.001) of the patients had been treated using combined therapy. Pain relief (43.3%) and psychosocial counseling (34.2%) were the most common form of palliative care (p=<0.001). The mean global QOL score was 2.8 (range 0-5) while the mean total weighted QOL score was 17.05 (range 0-30). Patients scored poorly on the wellbeing subscale (psychological dimension) mean -3.2 and highest in the symptom subscale (physical dimension) mean 8.5. Age, level of education, occupation, monthly income, marital status, types of cancer, the time since diagnosis, duration from last treatment and type of cancer treatment were the factors influencing QOL. Physical dimension showed that the total effect of patient socio-demographic characteristics and the indirect effect of socio-demographic characteristics through clinical characteristics significantly affected symptom and functional quality of life. These finding indicate variability in mean QOL score across the subscales, with symptom subscale contributing considerably more to the patients’ overall QOL. Patients’ interpersonal (social) and wellbeing (psychological) needs were not sufficiently recognized and addressed. There is need for palliative care specialist to recognize and consider the importance of psychological and social needs of patient, as well as to assess and manage symptom and functional domains. | en_US |