Date of Award

8-2025

Degree Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Advisor

Prof Gulnaz Mohamoud

Second Advisor

Dr. Roselyter Rianga

Third Advisor

Dr. Njeri Nyanja

Department

Family Medicine (East Africa)

Abstract

Background The growing burden of chronic diseases underscores the urgent need for palliative care integration into healthcare systems worldwide. Despite its benefits, palliative care remains underutilized due to various barriers, including health system limitations, institutional challenges, infrastructure gaps, and individual provider factors. However, limited research has explored the specific factors influencing physicians' decisions to refer patients to palliative care. This study sought to fill that gap by examining the key determinants shaping referral practices in a tertiary facility in Kenya.

Design and Methods This exploratory qualitative study examined 22 physician specialists from five departments at Aga Khan University Hospital, Nairobi. Participants were selected using purposive and quota sampling techniques. Semi-structured in-depth interviews were employed as the primary data collection method. Data analysis combined inductive and deductive thematic approaches using MAXQDA 22 software, guided by Braun and Clarke's (2006) framework.

Results This study highlighted the various factors informing physicians' decisions on palliative care referrals. Individual aspects, such as insufficient knowledge and training, emerged as factors influencing decision-making process. Additionally, perceived advantages and disadvantages of making referrals were identified as significant contributors. Interpersonal interactions, including physicians' engagement with palliative care specialists and their patients, also played a role in referral decisions. Furthermore, socio-cultural elements, such as personal and spiritual beliefs, societal taboos, and stigma surrounding palliative care, were revealed to shape these decisions.

Conclusion The study highlighted a significant knowledge gap on the scope of palliative care, optimal timing for referral and guidelines for referral exists amongst healthcare professionals. The paucity of palliative care specialists, few palliative care services, interprofessional differences, physician loss of income and high cost of care also impeded palliative care referrals. Existence of taboos and stigma amongst healthcare workers also negatively impacted referral.

First Page

1

Last Page

89

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