Open Access Research article

Outcomes 'out of africa': the selection and implementation of outcome measures for palliative care in Africa

Julia Downing1*, Steffen T Simon2, Faith N Mwangi-Powell3, Hamid Benalia4, Barbara A Daveson4, Irene J Higginson4, Richard Harding4, Claudia Bausewein4 and Project PRISMA

Author affiliations

1 Honorary Professor Palliative Care, Makerere University, Kampala, c/o PO Box 72518, Kampala. Formerly Deputy Executive Director, African Palliative Care Association, Kampala, Uganda

2 Department of Palliative Medicine and Clinical Trials Unit (BMBF 01KN1106), University Hospital Cologne, Kerpener Strasse 62, 50924 Köln, Germany

3 African Palliative Care Association, PO Box 72518, Kampala, Uganda

4 King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Denmark Hill, London, SE5 9PJ, UK

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Citation and License

BMC Palliative Care 2012, 11:1  doi:10.1186/1472-684X-11-1

Published: 6 January 2012



End-of-life care research across Africa is under-resourced and under-developed. A central issue in research in end-of-life care is the measurement of effects and outcomes of care on patients and families. Little is known about the experiences of health professionals' selection and implementation of outcome measures (OM) in clinical care, research, audit, or teaching in Africa.


An online survey was undertaken of those using outcome measures across the region, as part of the PRISMA project. A questionnaire addressing the use of OMs was developed for a similar survey in Europe and adapted for Africa. Participants were sampled through the contacts database of APCA. Invitation emails were sent out in January 2010 and reminders in February 2010.


168/301 invited contacts (56%) from 24 countries responded, with 78 respondents having previously used OM (65% in clinical practice, 12% in research and 23% for both). Main reasons for not using OM were a lack of guidance/training on using and analysing OM, with 49% saying that they would use the tools if this was provided. 40% of those using OM in clinical practice used POS, and 80% used them to assess, evaluate and monitor change. The POS was also the main tool used in research, with the principle criteria for use being validation in Africa, access to the tool and time needed to complete it. Challenges to the use of tools were shortage of time and resources, lack of guidance and training for the professionals, poor health status of patients and complexity of OM. Researchers also have problems analysing OM data. The APCA African POS was the most common version of the POS used, and was reported as a valuable tool for measuring outcomes. Respondents indicated the ideal outcome tool should be short, multi-dimensional and easy to use.


This was the first survey on professionals' views on OM in Africa. It showed that the APCA African POS was the most frequently OM used. Training and support are needed to help professionals utilise OM in palliative care, and OMs have an ongoing and important role in palliative care in Africa.

Palliative care; Online survey; Outcomes; Outcome measurement; Palliative care Outcome Scale (POS); APCA African POS; Research; Africa