Palliative Care Knowledge and Utilization Among Cancer Patients at Meru Teaching and Referral Hospital, Kenya

Despite global and national policy commitment to early palliative care integration, many cancer patients in sub-Saharan Africa remain unaware of, or do not utilize, palliative care services. This study examined how knowledge, awareness of available services, and familiarity with access and referral pathways influence the utilization of palliative care services among cancer patients at Meru Teaching and Referral Hospital, Kenya. Concurrent explanatory mixed methods design, informed by the pragmatist paradigm, was adopted. In the quantitative phase, a descriptive cross-sectional survey was administered to 395 adult cancer patients attending the oncology and palliative care clinics, selected through systematic random sampling. A qualitative phase comprising in-depth interviews with patients and key informant interviews with healthcare providers followed, with purposive sampling used to capture diverse perspectives. Quantitative data were analyzed descriptively and inferentially using chi-square tests and binary logistic regression in SPSS 31, while qualitative data were analyzed thematically and integrated with the quantitative findings at the point of interpretation. Slightly more than half of respondents (54.4%, n = 215) had heard of palliative care. Among these aware respondents, knowledge of palliative care was high (98.1%), yet 22.8% still believed palliative care was reserved for terminally ill patients. Utilization was high among aware respondents (74.4%). Knowledge level was significantly associated with utilization in bivariate analysis, χ²(2, n = 215) = 11.86, p = .003, but lost significance in a multivariate logistic regression (p = .123) once awareness of available services (Exp(B) = 6.39, p = .001) and access or referral familiarity (Exp(B) = 6.60, p < .001) were accounted for. These findings suggest that once patients reach a high knowledge floor, further gains in utilization depend less on general knowledge and more on awareness of specific services and clear referral pathways, alongside targeted correction of the persistent misconception that palliative care is reserved for the terminally ill. Standardized referral protocols and pathway-specific patient education are recommended. Keywords: Palliative Care, Knowledge, Utilization, Cancer Patients, Health Belief Model