Abstract:
BACKGROUND : Cervical cancer is mostly diagnosed at advanced stages among the majority of women in low-income
settings, with palliative care being the only feasible form of care. This study was aimed at investigating palliative care
knowledge and access among women with cervical cancer in Harare, Zimbabwe.
METHODS : Sequential mixed methods design was used, consisting of two surveys and a qualitative inquiry. A census of
134 women diagnosed with cervical cancer who visited two cancer treating health facilities and one palliative care
provider in Harare between January and April, 2018 were enrolled in the study. Seventy-eight health workers were also
enrolled in a census in the respective facilities for a survey. Validated structured questionnaires in electronic format
were used for both surveys. Descriptive statistics were generated from the surveys after conducting univariate analysis
using STATA. Qualitative study used interview/discussion guides for data collection. Thematic analysis was conducted
for qualitative data.
RESULTS : Mean ages of patients and health workers in the surveys were 52 years (SD = 12) and 37 years
(SD = 10,respectively. Thirty-two percent of women with cervical cancer reported knowledge of where to seek
palliative care. Sixty-eight percent of women with cervical cancer had received treatment, yet only 13%
reported receiving palliative care. Few women with cervical cancer associated treatment with pain (13%) and
side effects (32%). More women associated cervical cancer with bad smells (81%) and death (84%). Only one
of the health workers reported referring patients for palliative care. Seventy-six percent of health workers
reported that the majority of patients with cervical cancer sourced their own analgesics from private pharmacies.
Qualitative findings revealed a limited or lack of cervical cancer knowledge among nurses especially in primary health
care, the existence of stigma among women with cervical cancer and limited implementation of palliative policy.
CONCLUSIONS : This study revealed limited knowledge and access to palliative care in a low-income setting due to multifaceted
barriers. These challenges are not unique to the developing world and they present an opportunity for lowincome
countries to start considering and strategizing the integration of oncology and palliative care models in line
with international recommendations.
