Knowledge, Attitude, Practice and Barriers to Service Delivery of Paediatric Palliative Care Amongst Health Care Practitioners at Kenyatta National Hospital

Abstract

Background: Paediatric palliative care (PPC) services requires a broad multidisciplinary approach to provide comprehensive high-quality care for children. This can be achieved by having appropriate policies, adequate drug availability and educating the health care practitioners (HCPs). Despite having integrated hospice-palliative care services into mainstream service provision, there is scarcity of data on uptake, utilization, provision and barriers to PPC services delivery in Kenya. Objectives: Primary objectives were to assess knowledge, attitude and practice (KAP) of PPC amongst health care practitioners at Kenyatta National Hospital (KNH) and to explore barriers to PPC service delivery in KNH paediatric wards. Secondary objective was to determine factors associated with KAP of paediatric palliative care at KNH. Methods: Mixed-methods. Cross sectional study amongst HCPs. Quantitative approach was conducted by filling out a questionnaire to assess the level of KAP of PPC amongst HCPs at KNH. Through the qualitative approach, interviews were conducted with HCPs to explore factors affecting the PPC service delivery at KNH paediatric wards. Data analysis: Quantitative data obtained were exported to R and coded for statistical analysis. Median and interquartile ranges were used to summarize HCP knowledge, attitude and practice scores of PPC at KNH (primary objective). Multivariable logistical regression were used to determine factors associated with KAP of PPC at KNH (secondary objective). Qualitative data were analyzed using N-Vivo version 10 after verbatim transcription, translation and cleaning. Thematic content analysis was done to identify recurring themes. Data from the two research paradigms were integrated. Results: From the 233 nurses and residents, 40(17.2%) had good knowledge, 97(41.6%) had good practice and all participants had favorable attitude towards PPC. Males and residents were positively associated with good knowledge of PPC. Residents had a 35% likelihood of having poor practice of PPC. Main barriers to PPC service delivery included deficient knowledge, stigma, bureaucracy, poor and late referral processes and staff shortages. Conclusions: The HCPs had poor knowledge and practice, but their attitude towards PPC was favorable. The recommendations are for the different cadres and both genders to work together to ensure PPC services are initiated in a timely fashion and appropriately; on job continuous medical educations and trainings to bridge the gap of poor practice and deficient knowledge as well as demystifying the stigma surrounding palliative care. To expand the human resource as well as streamline referral processes and workplace bureaucracy.