title: What palliative care-related problems do patients with drug-resistant or drug-susceptible tuberculosis experience on admission to hospital? A cross-sectional self-report study.
abstract: The new World Health Organization's 'End TB' strategy specifies palliative care within its strategic pillars. Limited data on patient-reported problems are available to inform an effective care response.
  
  
  
  We aimed to (1) identify most burdensome problems, (2) compare intensity of problems for drug-susceptible and drug-resistant tuberculosis and (3) identify predictors of problem identifiers.
  
  
  
  Cross-sectional self-report quantitative study.
  
  
  
  Self-report palliative care problems (physical, psychological, social and spiritual) were collected among patients on admission to a general district hospital with tuberculosis and multidrug-resistant tuberculosis wards in South Africa.
  
  
  
  Totally, 114 patients were recruited. The items with worst score responses were worry (60.5%), pain (42.1%), help and advice to plan for the future (35.1%), symptoms (29.0%) and ability to share feelings (25.1%). In ordinal logistic regression, age was predictive of a higher (worse) score for total Palliative Outcome Scale total score (0.058, 95% confidence interval = 0.0018-0.099, p = 0.005) and Factor 2 (interpersonal wellbeing: 0.038, 95% confidence interval = 0.003-0.073, p = 0.031). Interestingly, multidrug-resistant tuberculosis was predictive of lower (better) score for both total Palliative Outcome Scale score and Factor 1 (physical and psychological wellbeing). Weight, human immunodeficiency virus status and prior treatment were not significantly associated with any of the three.
  
  
  
  Currently, patients with drug-susceptible tuberculosis are only admitted to hospital with complications, explaining their worse scores. The high burden of physical and psychosocial problems experienced by our sample provides strong evidence of the need for palliative care alongside potentially curative options.
authors.affiliation: Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK Richard.harding@kcl.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
authors.affiliation: Hospice Palliative Care Association of South Africa, Cape Town, South Africa African Palliative Care Association, Kampala, Uganda.
authors.forename: Kath
authors.initials: K
authors.lastname: Defilippi
authors.affiliation: Department of Family Medicine, University of Pretoria, Pretoria, South Africa Foundation for Professional Development, Pretoria, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Cameron
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D010166:Palliative Care; D010343:Patient Admission; D013019:South Africa; D014376:Tuberculosis; D018088:Tuberculosis, Multidrug-Resistant / Q000628:therapy*
keywords: Tuberculosis; drug resistance; hospital; palliative