Experience and satisfaction towards palliative care in an Ethiopian tertiary care setting: A mixed methods study of patients with cancer and caregivers

Patients and caregivers often face significant challenges in addressing palliative care needs in Ethiopia. This study aimed to assess patients treated for cancer and family caregiver satisfaction and experience towards palliative care at Tikur Anbessa Specialized Hospital (TASH). An explanatory mixed method study was conducted among patients treated for cancer and their family caregivers at TASH and data was collected from May 13 to August 30, 2024. A survey of 844 patients with cancer to assess satisfaction using SATMED-Q was conducted followed by interviews of 11 patients and 8 caregivers to explore their experience towards palliative care. Descriptive statistics summarized patient characteristics and a multiple linear regression analysis was conducted to identify factors associated with overall satisfaction. Qualitative analysis utilized thematic content analysis using MAXQDA. Overall mean patient satisfaction for palliative care was 56.7% ± 3.86. Significantly lower satisfaction was found among patients residing outside of Addis Ababa (β: -2.77, 95%CI:-5.29, -0.25, p:0.031). Lower satisfaction was also observed among patients with the reproductive system (β: -6.64, 95%CI:-10.38, -2.91, p < 0.0001), gastrointestinal (β: -4.11, 95%CI: -7.85, -0.38 p:0.031), head and neck (β: -11.56, 95%CI: -16.63, -6.50, p < 0.001), and lung and mediastinum (β: -9.96, 95%CI: -16.63, -6.50, p < 0.001) cancers as compared to patients with breast cancer. Patients experiencing moderate (β: 95%: -7.34, 95%CI: -10.26, -4.42, p < 0.001) and severe pain (β:-11.5, 95%CI: -13.05, -7.98, p < 0.001) also had lower satisfaction. Lack of whole-patient care, financial constraints, access to pain medications, physical inaccessibility of the care, poor coordination and continuity of care, and hospital infrastructure were mentioned as major systemic barriers. The study reveals significant dissatisfaction with palliative care in Ethiopia among patients with cancer, primarily due to pain management challenges, financial barriers, and systemic inefficiencies. These findings are consistent with previous studies and underscore the urgent need to integrate palliative care into primary healthcare, improve access to pain medications and coordinate holistic care.