Challenges of palliative care identified by stakeholders in resource-limited settings: A multi-regional study in Kazakhstan
Salikhanov I. Yuliya S. Aceti M. Schweighoffer R. Kunirova G. Khashagulgova F. Crape B.L. Katapodi M.C.
June 2024Elsevier Ltd
Journal of Cancer Policy
2024#40
Introduction: In Kazakhstan, a country of 19 million residents, more than 100,000 patients need palliative care. Since at least one family member is usually involved in the care of a terminal patient, more than 200,000 people would benefit from high-quality palliative care services in the country. However, with only 45 physicians and 101 nurses attending to 1925 palliative beds, Kazakhstan seeks to develop palliative services that meet the national needs in resource-limited settings and international standards. The objectives of this study are to explore the challenges faced by stakeholders involved in palliative care in Kazakhstan and to subsequently provide recommendations that can guide policymakers towards further developing palliative care services in the country. Methods: This cross-sectional descriptive study collected narrative data with in-depth interviews from n= 29 palliative stakeholders (family caregivers n= 12, healthcare professionals =12, administrators n= 5) across five regions of Kazakhstan. Verbatim transcripts of interviews were analyzed using content analysis to identify needs and challenges of stakeholders involved in palliative care. Results: Our analysis identified seven main challenges of palliative care stakeholders: high out-of-pocket expenditures; lack of mobile palliative care services for home-based care; severe shortages of opioids to prevent pain suffering; poor formal palliative care education; absence of practical skills training for family caregivers; lack of awareness about palliative care in the society, and lack of state support. Conclusion: Implementation of national palliative care strategies and policies require a large-scale coordinated involvement of all stakeholders. Our recommendations are based on the idea that coordinated, targeted, and tailored stakeholder engagement is preferred to a one-size-fits-all strategy.
Developing countries , End-of-life care , Resource-limited settings , Stakeholder perspectives
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University of Basel, Department of Clinical Research, Davidsbodenstrasse 28, Basel, 4056, Switzerland
Kostanay City Oncological Multidisciplinary Hospital, Kostanay, Kazakhstan
University of Basel, Department of Clinical Research, Basel, Switzerland
President of the Kazakhstan Association of Palliative Care, Almaty, Kazakhstan
National Research Cardiac Surgery Center, Astana, Kazakhstan
Nazarbayev University School of Medicine, Kazakhstan
University of Basel, Department of Clinical Research, Switzerland
University of Basel
Kostanay City Oncological Multidisciplinary Hospital
University of Basel
President of the Kazakhstan Association of Palliative Care
National Research Cardiac Surgery Center
Nazarbayev University School of Medicine
University of Basel
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