Health care seeking behaviors and perspective on indigenous palliative care among cancer patients in Kenya.

INTRODUCTION: Holistic integrated community palliative care services remain a mirage to cancer patients. Nonetheless, a number of cancer patients are jamming traditional medicinal places seeking therapy. The results of these visits are undocumented. This study explored healthcare seeking behaviors and perspectives on cancer indigenous palliative care among patients visiting traditional health practitioners in Kenya. METHODS: A cross-sectional study was undertaken through client exit survey. Face to face interviews were conducted using semi-structured questionnaires with all consenting cancer patients exiting mapped outlets. Data was analyzed using Statistical Package for Social Science Version 22.0. RESULTS: A total of 433 respondents were interviewed and the majority were female 59.6%, Christians 97.2%, married 89.8% and educated 85.7%. Their mean age was 48.25 ± 15. 58. Education, sex and religion were significantly associated with perceived improvement. The predominant cancer types were breast cancer (22.4%); throat (14.8%), prostate (12.9%), bone (12.5%), cervical (9.9%), stomach (6.0%) and skin cancer (5.1%). The most frequently used traditional medicine was herbal medicine that was driven by unresponsive conditions (42.2%), inaccessible biomedical services (18.8%) and yearning for second opinion (18%) over a condition. Seventy six percent of the respondents reported improved and prolonged quality of life. 78.2% reported improved eating, drinking, standing, walking and doing light duties alone. Patients felt healthier, hopeful, happier, confident and bonded to their families. CONCLUSIONS: Use of indigenous palliative care is predominant to all major cancer conditions and driven by the quest for cure, successful stories, trustworthiness and beliefs, previous experience and avoiding medical procedures such as surgery.

Providers' Understanding of Cancer Aetiology and Supportive Features for Indigenous Palliative Cancer Care Service Provision in Kenya.

Background: Palliative care is a fundamental component of providing people-centred health services to cancer patients. However, the primary pillars of indigenous palliative care such as provider understanding of cancer, its aetiology, and features are undocumented. Objective: We sought to understand Traditional Health Providers (THPs) understanding of cancer aetiology, and the functional features that support indigenous palliative cancer care service provision in Kenya. Method: The study used a mixed methods cross-sectional design. A semi-structured questionnaire was administered to 193 THPs, who self-reported to manage cancer patients. The findings were enriched and validated through member checking in 6 focus group discussions and five journey mapping in-depth interviews. Results: Despite diversity in culture and experience among the indigenous providers in Kenya, their description of cancer etiology and their management practices and primary goal were similar. Cancer was consistently described as a deadly life-deforming disease by 61.1% of THPs (n = 118/193) and attributed to chemicals and toxins in the body 41.5% (n = 80). The indigenous palliative-care system was reported to be characterized by five tiered levels of care, diversity in expertise and experience, shared and consultative process (60%) and family involvement in medical decision (59.5%). Herbal regimen (60.1%) was found to be the cornerstone of informal palliative care blended with nutrition management 78.2% (n = 151), lifestyle changes 63.7% (n = 123) and counseling services 55.9% (n = 108). Payments for service were arbitrarily made in cash or in kind. Conclusion: The features of indigenous palliative care services are informed by the providers' distinctive cultural terms and descriptions of cancer and cancer aetiology. Shared and consultative protocols, regimen exchange, referral to cascaded care, and caregiver involvement were all important palliative-care clues to saving and enhancing lives. The features provide context for development of indigenous palliative care framework, engagement of policy makers, and promotion of culturally-inclusive indigenous palliative care model for adoption.