This study aimed to investigate the palliative care delivery to patients with advanced cervical cancer at a specialised tertiary hospital in Ethiopia. The study identified poor knowledge of comprehensive palliative care. It also revealed that the patients had received some form of palliative care; however, it was non-comprehensive and inadequate. The level of pain and symptoms control, mental care, socio-economic assistance and spiritual support was minimal. In contrast, the patients reflected a positive attitude towards palliative care.

There is no familiar terminology in the local language, Amharic, to assess the knowledge regarding palliative care. In this study, palliative care was translated as “care to relieve symptoms”, translated into Amharic as , /yämastagäsha enkbkabä/. About a quarter of the patients (26%) knew palliative care as a comprehensive pain and symptom management and socio-economic and psychological support. However, the majority (63%) defined palliative care as a pain treatment. A study conducted in the same setting reported that 62% of the patients diagnosed with cancer have some knowledge about palliative care [20]. Illiteracy could have contributed to the poor knowledge.

Pain control was the commonly known type of palliative care, whereas symptom control, counselling, and education were understood among less than a quarter of patients. Spiritual, social and economic support, and bereavement care were almost unknown. Only 2% considered preparing for death as palliative care. In Ethiopia, there are cultural and religion-related sensitivities when disclosing the reality to the patients and families; consequently, physicians or nurses refrain from talking about the enduring nature of the disease, dying and preparing for death [25].

Knowledge about palliative care varies with different factors, including educational status, age, gender, palliative care training, caregiver experience, and profession [26]. A study conducted in Ecuador showed that 79% of the general population had heard about palliative care; the knowledge varied by education, palliative care training, health-related occupation, and gender [27]. However, a study on the general population of Northern Ireland showed that only 20% knew the accurate term, “palliative care” [26]. Similarly, only 29% of adults in the United States expressed good knowledge regarding palliative care [28]. In addition, only 29% of the patients reported good palliative care knowledge in Zimbabwe [29] and Saudi Arabia [30].

This study documented a positive attitude towards palliative care. The four categories of attitude assessment tool were attitude towards suffering during the death process, perception regarding anti-pain drugs, attitude towards palliativ e car e service s, and feelings towards palliative care physicians . A relatively poorer attitude was found in attitude towards talking about death and the process of dying. It has bee n show n that 56% of the participants reported that talking about death and the process of dying made them lose hope. The finding is high compared to the study done in the Un ited States in 2013, where only 20% had such an attitude [23]. In this study, a high proportion of the respondents (57%) accepted suffering as part of dying. In contrast, o nly 28% agreed with this attitude in the study conducted in the United States [23].

Attitude towards treatment with morphine and other anti-pain drugs was good. More than 80% of the respondents had a positive attitude; for example, 84% of the participants disagreed that treating patients with morphine or other anti-pain causes addiction. A similar proportion (87%) disagreed that it causes addiction in the study conducted in the United States [23]; however, a higher proportion of Canadian patients (42%) felt it could cause addiction, and 54% felt that morphine could make the patient die sooner [22]. In this study, more than half (56%) agreed that “morphine and other analgesics could make patients feel better and live longer.” However, a higher proportion (82%) of the United States [23] and Canadian (94%) patients [22] felt that the analgesics could make them feel better.

Most of the respondents (97%) had received home care from caregivers. In addition, about 90% of the patients had ever received treatment for the concerning symptoms, including pain, vaginal bleeding, or vaginal discharge. This number is higher than a study done in the same setting in 2014, where 69% of the patients received palliative care services [20]. However, control of the symptoms, including pain, was low.

Among the 90% of patients who had experienced pain, about 11% did not receive any analgesics. Only 56% of patients who received anti-pain drugs controlled the pain. This finding aligns with studies reporting that most physicians and nurses in Ethiopia were reluctant to treat pain [31, 32]. In a study done in the same setting, 93% of cancer patients experienced pain, and 42% had no treatment. Among those treated, 44% received inadequate pain management and inappropriate drugs [33]. Knowledge among healthcare workers could influence the treatment of pain. A survey conducted by the Ministry of Health and partners in Ethiopia showed that only 30% of health workers could conduct correct pain assessments, and 27% did not know the contraindications of anti-pain drugs [32]. Another study in Ethiopia showed that 90% of patients with chronic diseases experienced pain, but only 24% received anti-pain prescriptions [34].

This study identified that the psychological, socio-economical and spiritual component of palliative care was poor among patients with advanced cervical cancer. Only 20% of the respondents in this study received counselling at the centre or in hospitals elsewhere, and a similar proportion received education regarding cervical cancer. About 30% of them received counselling by spiritual persons. In contrast, a study conducted in the same setting showed that a higher proportion (45%) of the patients with cancer received counselling within a year of follow-up [20].

This study has some limitations. Firstly, it was conducted among patients visiting a tertiary hospital. Although the hospital is the only place to access patients with advanced cervical cancer, the study excluded patients who died before appropriate diagnosis or those who did not attend the centre. Secondly, the palliative care assessment was limited to patients with advanced-stage, excluding the care provided at the early stage, end-of-life, and bereavement time.