• Keith R Love, Elizabeth Karin, Daniel Morogo, Florence Toroitich, Juli M Boit, Allison Tarus, Felix A Barasa, Nathan E Goldstein, Myra Koech, and Rajesh Vedanthan.
• Yale New Haven Hospital, New Haven, Connecticut, USA. Electronic address: keith.love@yale.edu.
• J Pain Symptom Manage. 2020 Oct 1; 60 (4): 717-724.

ContextCardiovascular disease (CVD) is the leading cause of death globally and a significant health burden in Kenya. Despite improved outcomes in CVD, palliative care has limited implementation for CVD in low-income and middle-income countries. This may be partly because of providers' perceptions of palliative care and end-of-life decision making for patients with CVD.ObjectivesOur goal was to explore providers' perceptions of palliative care for CVD in Western Kenya to inform its implementation.MethodsWe conducted eight focus group discussions and five key informant interviews. These were conducted by moderators using structured question guides. Qualitative analysis was performed using the constant comparative method. A coding scheme was developed and agreed on by consensus by two investigators, each of whom then independently coded each transcript. Relationships between codes were formulated, and codes were grouped into distinct themes. New codes were iteratively added with successive focus group or interview until thematic saturation was reached.ResultsFour major themes emerged to explain the complexities of integrating of palliative care for patients with CVD in Kenya: 1) stigma of discussing death and dying, 2) mismatch between patient and clinician perceptions of disease severity, 3) the effects of poverty on care, and 4) challenges in training and practice environments. All clinicians expressed a need for integrating palliative care for patients with CVD.ConclusionThese results suggest that attainable interventions supported by local providers can help improve CVD care and quality of life for patients living with advanced heart disease in low-resource settings worldwide.Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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