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Depressive Symptoms and Palliative Care Concerns Among Patients With Non-communicable Diseases in Two Southern African Countries

      Abstract

      Context

      Non-communicable diseases (NCDs), associated with health-related suffering, can benefit from palliative care in resource-limited settings, where over four-fifths of these deaths occur.

      Objective

      To measure the prevalence of depressive symptoms, palliative care-related concerns, physical and other psychological symptoms among adult patients with NCDs in Malawi and Namibia.

      Methods

      This multi-center, cross-sectional study consecutively recruited outpatients from four tertiary referral hospitals. Stepwise regression analysis was used to assess factors associated with physical and psychological symptom burden.

      Results

      Among 457 participants, primary diagnosis was cancer (n=147, 32%); cardiovascular disease (CVD) (n=130, 28%), chronic respiratory disease (CRESD) (n=73, 16%) or diabetes (n=107, 23%). Over half were female (58.9%; n=269), mean age was 48 (SD=15.7). Clinically significant psychological distress was identified among cancer (57.2%), diabetes (57.0%), CRESD (45.2%) and CVD patients (43.1%), with criterion for major depression symptoms met for cancer (42.9%), diabetes (39.2%), CVD (30.0%) and CRESD (28.8%). Most severe palliative care concerns were: first sharing feelings (i.e., not at all/not very often), reported by CVD (28%), CRESD (23%), cancer (22%) and diabetes (21%) patients; second help and advice (i.e., none/very little), among cancer (28%), CVD (26%), diabetes (22%), and CRESD (16%) patients. High prevalence of moderate-to-severe pain was reported (cancer 54%, CVD 41%, CRESD 38%, diabetes 38%). Functional status, age, and presence of comorbidities were associated with physical and psychological symptom distress.

      Conclusion

      Given the high burden of physical and psychosocial symptoms and symptom distress, the findings highlight the need for integrated person-centered palliative care for NCDs to optimize care outcomes.

      Key Words

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      References

        • Knaul F
        • Bhadelia A
        • Atun R
        • et al.
        Palliative care: an essential facet of universal health coverage.
        Lancet Glob Health. 2019; 7: e1488
        • Sleeman KE
        • Gomes B
        • de Brito M
        • et al.
        The burden of serious health-related suffering among cancer decedents: global projections study to 2060.
        Palliat Med. 2021; 35: 231-235
        • Knaul FM
        • Farmer PE
        • Krakauer EL
        • et al.
        Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report.
        Lancet. 2018; 391: 1391-1454
        • Grant L
        • Brown J
        • Leng M
        • et al.
        Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies.
        BMC Palliative Care. 2011; 10 (8-8)
        • Lynch T
        • Connor S
        • Clark D
        Mapping levels of palliative care development: a global update.
        Journal of Pain and Symptom Management. 2013; 45: 1094-1106
        • Powell RA
        • Mwangi-Powell FN
        • Kiyange F
        • et al.
        Palliative care development in Africa: how can we provide enough quality care?.
        BMJ Support Palliat Care. 2011; 1: 113-114
        • Rhee JY
        • Garralda E
        • Namisango E
        • et al.
        Factors affecting palliative care development in Africa: in-country experts’ perceptions in seven countries.
        J Pain Symptom Manage. 2018; 55 (e2): 1313-1320
        • Lemoine M
        • Girard PM
        • Thursz M
        • et al.
        In the shadow of HIV/AIDS: forgotten diseases in sub-Saharan Africa: global health issues and funding agency responsibilities.
        J Public Health Policy. 2012; 33: 430-438
        • Powell RA
        • Ali Z
        • Luyirika EBK
        • et al.
        Out of the shadows: non-communicable diseases and palliative care in Africa.
        BMJ Support Palliat Care. 2017; 7: 128-132
        • Solano JP
        • Gomes B
        • Higginson IJ
        A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease.
        J Pain Symptom Manage. 2006; 31: 58-69
        • Moens K
        • Higginson IJ
        • Harding R
        Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review.
        J Pain Symptom Manage. 2014; 48: 660-677
        • Hotopf M
        • Mayou R
        • Wadsworth M
        • et al.
        Temporal relationships between physical symptoms and psychiatric disorder. Results from a national birth cohort.
        Br J Psychiatry. 1998; 173: 255-261
        • Hotopf M
        • Chidgey J
        • Addington-Hall J
        • et al.
        Depression in advanced disease: a systematic review Part 1. Prevalence and case finding.
        Palliat Med. 2002; 16: 81-97
        • Harding R
        • Selman L
        • Agupio G
        • et al.
        The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries.
        Eur J Cancer. 2011; 47: 51-56
        • Harding R
        • Powell RA
        • Namisango E
        • et al.
        Palliative care-related self-report problems among cancer patients in East Africa: a two-country study.
        Support Care Cancer. 2014; 22: 3185-3192
        • Farrant L
        • Gwyther L
        • Dinat K
        • et al.
        Maintaining wellbeing for South Africans receiving ART: the burden of pain and symptoms is greater with longer ART exposure.
        S Afr Med J. 2014; 104: 119-123
        • van Niekerk L
        • Raubenheimer PJ
        A point-prevalence survey of public hospital inpatients with palliative care needs in Cape Town, South Africa.
        S Afr Med J. 2014; 104: 138-141
      1. World Health Organization, Noncommunicable diseases: fact sheet. 2017.

        • Christians F
        Country profile - Primary healthcare and family medicine in Namibia.
        Afr J Prim Health Care Fam Med. 2020; 12: e1-e3
        • Ministry of Health and Social Services
        National multisectoral strategic plan for prevention and control of non-communicable diseases (NCDs) in Namibia 2017/18 –2021/22.
        Ministry of Health and Social Services, Namibia, Windhoek2017
        • World Bank
        The world bank in Malawi.
        The World Bank in Malawi, Lilongwe2019
        • Gowshall M
        • Taylor-Robinson SD
        The increasing prevalence of non-communicable diseases in low-middle income countries: the view from Malawi.
        International journal of general medicine. 2018; 11: 255-264
      2. Ministry of Health Malawi. The health care system. 2016 [cited 2022 July 2022]; Available from: https://www.health.gov.mw/index.php/2016-01-06-19-58-23/national-aids.

        • Gouda HN
        • Charlson F
        • Sorsdahl K
        • et al.
        Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the Global Burden of Disease Study 2017.
        Lancet Glob Health. 2019; 7: e1375-e1387
      3. Karnofsky D, J Burchenal, The clinical evaluation of chemotherapeutic agents in cancer. Evaluation of chemotherapeutic agents, ed. M. CM. 1949, New York: Columbia University Press.

        • Katwere M.
        • Kambugu A
        • Piloya T
        • et al.
        Clinical presentation and aetiologies of acute or complicated headache among HIV-seropositive patients in a Ugandan clinic.
        J Int AIDS Soc. 2009; 12: 21
        • Anderson F
        • Downing GM
        • Hill J
        • et al.
        Palliative performance scale (PPS): a new tool.
        J Palliat Care. 1996; 12: 5-11
        • Powell RA
        • Downing J
        • Harding R
        • et al.
        Development of the APCA African palliative outcome scale.
        J Pain Symptom Manage. 2007; 33: 229-232
        • Harding R
        • Selman L
        • Agupio G
        • et al.
        Validation of a core outcome measure for palliative care in Africa: the APCA African palliative outcome scale.
        Health Qual Life Outcomes. 2010; 8: 10
        • Downing J
        • Simon ST
        • Mwangi -Powell FN
        • et al.
        Outcomes ‘out of africa’: the selection and implementation of outcome measures for palliative care in Africa.
        BMC Palliative Care. 2012; 11 (1-1)
        • Namisango E
        • Bristowe K
        • Allsop MJ
        • et al.
        Symptoms and concerns among children and young people with life-limiting and life-threatening conditions: a systematic review highlighting meaningful health outcomes.
        Patient. 2019; 12: 15-55
        • Chang VT
        • Hwang SS
        • Feuerman M
        • et al.
        The memorial symptom assessment scale short form (MSAS-SF).
        Cancer. 2000; 89: 1162-1171
        • Chang VT
        • Hwang S S
        • Kasimis B
        • et al.
        Shorter symptom assessment instruments: the condensed memorial symptom assessment scale (CMSAS).
        Cancer Invest. 2004; 22: 526-536
        • Wakeham K
        • Harding H
        • Bamukama D
        • et al.
        Symptom burden in HIV-infected adults at time of HIV diagnosis in rural Uganda.
        J Palliat Med. 2010; 13: 375-380
        • Radloff
        The CES-D scale: a self report depression scale for research in the general population.
        Applied Psychological Measurements. 1977; 1: 385-401
        • Myer L
        • Smit J
        • Le Roux L
        • et al.
        Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales.
        AIDS Patient Care STDS. 2008; 22: 147-158
        • Nakasujja N
        • Skolasky SL
        • Musisi S
        • et al.
        Depression symptoms and cognitive function among individuals with advanced HIV infection initiating HAART in Uganda.
        BMC Psychiatry. 2010; 10: 44
        • World Health Organisation
        Global status report on noncommunicable diseases 2010. World Health Organisation, Geneva2019
        • Rayner L
        • Hotopf M
        • Petkova H
        • et al.
        Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs.
        Pain. 2016; 157: 1472-1479
        • Rayner L
        • Price A
        • Hotopf M
        • et al.
        The development of evidence-based European guidelines on the management of depression in palliative cancer care.
        Eur J Cancer. 2011; 47: 702-712
        • Rayner L HI
        • Price A
        • Hotopf M
        The management of depression in palliative care: European clinical guidelines.
        Cicely Saunders Institute, King’s College London and Palliative Care Research Collaborative London, London2010
        • Gomes B
        • Calanzani N
        • Curiale V
        • et al.
        Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers.
        Cochrane Database Syst Rev. 2013; 6: Cd007760
        • WHA
        Strengthening of palliative care as a component of integrated treatment within the continuum of care.
        in: 134th Session of the World Health Assembly EB134.R7 May 2014. 2014
        • Association A.P.C.
        Essential palliative care package for universal health coverage P. Palliative Care Association of Uganda, Kampala2019
      4. Palliative Care Association of Uganda. Essential palliative care package for universal health coverage in Uganda. 2021 [cited 2022 July 2022].

        • Santana MJ
        • Manalili K
        • Jolley RJ
        • et al.
        How to practice person-centred care: a conceptual framework.
        Health Expect. 2018; 21: 429-440
        • Abegunde D
        Essential medicines for non-communicable diseases(NCDs). 5. World Health Organization, Geneva2011