Medical Dilemma Research Articles

Motherhood and rheumatic disease – a balancing act. A qualitative study on the challenges of mothers with inflammatory arthritis

ObjectiveInflammatory arthritis (IA) often come with symptoms of pain, stiffness and fatigue, as well as fluctuating and unpredictable disease patterns. All of these symptoms can cause challenges in the role as a mother for women with IA. The main objective of this study is to gain a broader understanding of how mothers with IA experience motherhood and the challenges they encounter within a biopsychosocial framework.MethodsThe participants in this study were recruited through RevNatus, a Norwegian nationwide quality register. The sample consisted of women with IA who had given birth within the last 5 years. The data consisted of written answers to an open-ended question: “Is there anything, in particular, you have experienced as challenging with being a mother and having a rheumatic disease at the same time”? The data were analysed following Brinkmann and Kvale's qualitative content analysis.Results186 women answered the open-ended question. The responses consisted of a total of 9,000 words. Motherhood with IA was described as a difficult balancing act, with practical and physical challenges affecting day-to-day life, medical dilemmas, as well as challenges on a deeper emotional level and worries for the future.ConclusionThe main finding in this study is that the challenges these women meet are multifactorial and complex, including physical, mental and social issues that have a large impact on their everyday life. Focusing solely on improving medical treatment will not solve the challenges these women face. A multidisciplinary approach and focus on patient education and self-management strategies is important to help these women thrive in their role as mothers with IA.

Investigation of resveratrol as a xanthine oxidase inhibitor: Mechanistic insights and therapeutic implications for gout and hyperuricemia.

Gout predominantly stems from hyperuricemia, precipitating the accumulation of urate crystals and consequent joint inflammation, swelling, and pain, thereby compromising the quality of life and presenting a formidable medical dilemma. Although conventional treatments like allopurinol and febuxostat target uric acid reduction via xanthine oxidase (XO) inhibition, they often entail adverse effects, prompting the exploration of safer alternatives. Resveratrol, a polyphenolic compound abundant in fruits and vegetables, has emerged as a potential XO inhibitor. However, its precise inhibitory mechanisms remain poorly understood. This study aims to comprehensively investigate resveratrol's XO inhibition through mechanistic insights, molecular docking simulations, animal model experiments, and biochemical analysis, contributing valuable insights to the development of novel therapeutics for hyperuricemia and gout.

The Survival and Medical Dilemma of Rare Disease Patients in the Greater Bay Area

The population of rare disease patients in China faces many difficulties in disease diagnosis and treatment, medical security, economic burden, quality of life, social assistance, employment opportunities, mental health, and other aspects. It is of great significance to identify the common problems faced by this group and try to propose possible solutions, calling on all sectors of society to pay attention to the rare disease minority group, help them solve their survival and security difficulties, and enable more patients to return to society. This paper investigates and addresses the survival and security challenges faced by rare disease minority patients in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) of China. Through a survey of 223 rare disease patients in the Greater Bay Area, the study reveals that these patients face many challenges in diagnosis, treatment, drug access, and economic support. The conclusion emphasizes the necessity of improving diagnostic efficiency, accelerating drug development, and improving the medical insurance system. Thus, it further puts forward practical suggestions.

Medical dilemma: Programmed death 1 blockade (sintilimab) therapy in patients suffering from tumours combined with psoriasis.

Tumour immunotherapy represented by immune checkpoint inhibitors (ICIs) has greatly improved the overall prognosis of patients with malignant tumours, and is regarded as an important breakthrough in the field of medicine in recent years. ICIs have gradually become the core of tumour therapy and are increasingly used in the clinic. In order to achieve early clinical prediction and management of immune-related adverse events (irAEs), it is still necessary to perform further research on the mechanisms, risk factors, and predictors of irAE occurrence in the future. Zhou et al describe the consultation of a patient with advanced gastric cancer combined with chronic plaque psoriasis. This case provides an important reference for the use of programmed cell death protein-1 (PD-1) inhibitors in patients of tumours combined with chronic plaque psoriasis. This case also highlights that screening of high-risk groups for irAEs is critical before applying PD-1 inhibitors to patients with chronic psoriasis combined with tumours. PD-1 inhibitors are new and potent antineoplastic agents that can cause serious immune-related adverse events such as toxic epidermal necrolysis release and psoriasis. Glucocorticosteroids are the first-line agents for irAEs. The incidence of rheumatic irAEs may be higher in reality, which will inevitably become a new challenge for rheumatologists and dermatologists.

The problem of unconscious and unidentified patients in emergency department admissions; a 3-year retrospective study.

Unidentified patients present a medical information dilemma for all medical departments but can be a major problem in Emergency Departments (EDs). This study aimed to determine the clinical and socio-demographic profile of 'unidentified' patients admitted to the ED with altered consciousness and to define the outcomes of these patients. All ED presentations were analyzed retrospectively for the unidentified patients brought to the hospital by ambulance with altered consciousness. We assessed demographic data, clinical presentation, discharge information, and major clinical outcomes. In this study, 1324 unidentified patients were admitted with altered consciousness to the ED. Of these, 1048 (80.1%) were foreign nationals. In this patient group, the most common diagnoses were; traffic accidents, assault or sharp object injuries, drug addicts, or syncope-epilepsy. In addition, the number of patients who left the hospital without permission or escaped and therefore could not be diagnosed was higher in the foreign nationalities group and constituted approximately one-fifth of the patients (18.9% vs. 5.4%, p:0.001). Of the unidentified patients, 903 (68.2%) were discharged after treatment. 351 (26.5%) patients left the ED unattended. 32 (2.4%) patients were hospitalized. 38 (2.9%) patients died in ED. The majority of the unidentified patients admitted to the ED with altered consciousness were immigrant males. Unidentified patients are a high-need population, most commonly presenting with substance misuse or trauma. Although most of the patients were seeking urgent treatment, more than one-fourth of the patients left the hospital without appropriate treatment and most of these patients were also immigrants. We believe that economic, linguistic, and social disadvantages played an important role in this outcome.

Severe amlodipine toxicity: A medical dilemma managed with therapeutic plasma exchange

Amlodipine poisoning is a nightmare for treating clinicians because of the intractable hypotension and bradycardia induced by the drug, which requires a balanced treatment algorithm. We encountered a case of severe Amlodipine toxicity (450 mg) who presented with complaints of nausea, multiple episodes of vomiting, and chest discomfort. On arrival at the EMD, the patient had significant hypotension (80/46 mmHg), bradycardia (40 beats/min), and a fall in oxygen saturation (75 %). He was symptomatically managed with inotropes, IV calcium, IV fluids, and oxygen supplementation. We decided to go forward with Therapeutic Plasma Exchange (TPE) in an attempt to remove the inciting agent. Two sessions of TPE were performed and the patient showed significant improvement post-procedure which led to the discharge of the patient within 10 days of admission. This case report highlights the noteworthiness of TPE in treating significantly high doses of drug poisoning.

Experiences of Deployed Physicians in Support of Operation Allies Refuge/Operation Allies Welcome: Lessons to Inform Improvements in Training.

Stability operations, including humanitarian assistance and disaster relief missions, are key functions of U.S. Military medicine and the Military Medical Humanitarian Assistance Course (MMHAC) is a 2-day course widely used to prepare military medical personnel for such missions. It focuses on caring for those most vulnerable in the wake of disasters, particularly children. The large-scale humanitarian deployment of military medical providers in support of Operation Allies Welcome/Operation Allies Refuge (OAW/OAR) presents an opportunity to evaluate the preparedness of these providers to care for the needs of the Afghan travelers, so we explored the experiences of military medical providers deployed in support of OAW/OAR to inform improvements in the MMHAC. We conducted a qualitative study of military medical providers who were deployed in support of OAW/OAR using a series of three virtual focus groups. Focus group questions were structured around the main topics covered in the MMHAC (patient care, ethical considerations, logistical concerns, and preventive and public health) and explicitly asked about adaptive leadership challenges faced and strategies used to overcome them. We analyzed transcripts using inductive thematic analysis within a constructivist paradigm, with adaptive leadership as a sensitizing concept. The study was approved by the Institutional Review Board of Uniformed Services University. We constructed 4 themes from participant responses, each addressing challenges that medical providers faced during their mission: (1) Medical providers navigated tension between medical and public health priorities and military mission priorities; (2) Chronic and complex care needs posed unique challenges for medical personnel; (3) Challenges in patient care were compounded by logistical and system-based barriers; and (4) Cultural barriers led to ethical dilemmas that physicians felt inadequately prepared to handle, most notably with respect to gender-related concerns. Within each theme, participants described which aspects of MMHAC training were most helpful and which areas were inadequate. Physicians found the OAR/OAW mission meaningful but also identified challenges related to medical care provision, public health, logistics, and ethical dilemmas that hindered their ability to carry out their medical mission. Lessons learned from OAW/OAR highlight several areas in which the MMHAC training could be augmented and improved to further mitigate these challenges.

An Artificial Appetite: The Nineteenth-Century Struggle to Define Habitual Drunkenness

summary: After discovering in 1811 that alcohol existed as a discrete chemical substance in all intoxicating drinks, physicians reconsidered the individual’s responsibility for becoming a compulsive drinker. Looking to science and medicine for legitimacy, temperance reformers ascribed a deleterious agency to alcohol and personified it as an agent of physiological destruction. Alcohol destroyed the body and transformed natural alimentary desires into a compulsive artificial appetite for alcohol. Reformers, prohibitionists, and physicians were troubled that alcohol possessed the ability to destroy the physical capacity for the power of choice. Ascribing agency to alcohol destabilized long-standing understandings of intemperance as a vice and imbued habitual drunkenness with medical meanings. However, most professionals remained anxious about absolving the habitual drunkard of all responsibility, especially for taking the first drink. An inchoate attempt to capture the medical and moral dilemmas of compulsion, habitual drunkenness represents a conceptual missing link in the genealogy of addiction.

The big heroine genre: motherhood and the maternal body in postsocialist Chinese television

This article explores the feminist social critique in the ‘big heroine’ drama, a newly emerged genre of television that focuses on empowering yet dramatic stories of urban women in contemporary...

Ethical and Medical Dilemmas of Extreme Tourism

Originally funded and experienced by millionaires and billionaires willing to spend hundreds of thousands or even millions for an extreme adventure where previously only explorers and scientists previously dared to go, extreme environment (i.e. polar, tundra, desert, space, space analog, deep ocean, mountaineering, nuclear meltdown sites etc.) tourism is becoming more common allowing more people to be exposed to increased dangers and risks that such tourists will be exposed to. Some of those risks might be relatively minor such as possibly minor motion sickness. Other risks, however, could include serious injury, such as in the case of the Titan submarine which imploded on a tour to the Titanic in June 2023, death. The disaster, caused primarily by cost cutting measures and disregard of the danger from the company running the tour, which caused all 5 people on board to be killed instantaneously. This presentation and paper will expand on previously published work on the medical and ethical dilemmas of space tourism as well as include an additional focus on tourism to other extreme environments including the neonate industry of space analog tourism where individuals pay to participate in a space analog mission at a hefty fee while potentially contributing or disrupting the legitimate scientific research going on such missions while still exposing themselves to additional risk which they might be unsuited for. Further, this will discuss a few of the lesser known risks and concerns that have come more recently to light as well as a discussion as to not only if adults should be able to ethically, morally, and legally consent for their children during these high risk activities but whether or not, given the human brain does not fully develop until a person is in their mid-20s, how old should a person be in order to adequately understand and appropriately balance the risks and requirements of an extremely dangerous environment and be able to fully consent to the tourism venture’s risks.

Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU: A User-Centered Design for Rapid Prototyping

ObjectiveRenal replacement therapy (RRT) is increasingly adopted for critically ill patients diagnosed with acute kidney injury, but the optimal time for initiation remains unclear and prognosis is uncertain, leading to medical complexity, ethical conflicts, and decision dilemmas in intensive care unit (ICU) settings. This study aimed to develop a decision aid (DA) for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians. MethodsDevelopment of DA employed a systematic process with user-centered design (UCD) principle, which included: (i) competitive analysis: searched, screened, and assessed the existing DAs to gather insights for design strategies, developmental techniques, and functionalities; (ii) user needs assessment: interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs; (iii) evidence syntheses: integrate latest clinical evidence and pertinent information to inform the content development of DA. ResultsThe competitive analysis included 16 relevant DAs, from which we derived valuable insights using existing resources. User decision needs were explored among a cohort of 15 family surrogates, revealing four thematic issues in decision-making, including stuck into dilemmas, sense of uncertainty, limited capacity, and delayed decision confirmation. A total of 27 articles were included for evidence syntheses. Relevant decision-making knowledge on disease and treatment, as delineated in the literature sourced from decision support system or clinical guidelines, were formatted as the foundational knowledge base. Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT, possible outcomes, and reasons to choose. The DA was drafted into a web-based phototype using the elements of UCD. This platform could guide users in their preparation of decision-making through a sequential four-step process: identifying treatment options, weighing the benefits and risks, clarifying personal preferences and values, and formulating a schedule for formal shared decision-making with clinicians. ConclusionsWe developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting. Future studies are needed to evaluate its usability, feasibility, and clinical effects of this intervention.

Evidence-Based Care of Staircase Recruitment Maneuver in a Patient with Severe Acute Respiratory Distress Syndrome

<p>急性呼吸窘迫症是致死率很高的急症，嚴重呼吸困難會造成病人有瀕死的危象。筆者於2020 年11月照顧一位67歲男性因急性呼吸衰竭插管治療，對於肺保護通氣策略之效果不佳，甚至使用體外膜氧合維生系統仍嚴重低血氧，引發筆者想解決此醫療困境之動機。運用實證步驟探討階梯式肺再擴張術增加氧合能力之成效，以PICO詮釋臨床問題，P為急性呼吸窘迫症（Acute respiratory distress syndrome, ARDS）、I為階梯式肺再擴張術（Staircase recruitment maneuver, SRM）、C為常規照護（Usual care）、O為氧合能力（PaO2/FiO2 ratio, PFR），檢索Cochrane Library、PubMed、CINAHL和華藝線上圖書館等資料庫，最終納入五篇符合篩選標準之隨機對照試驗研究，經系統性回顧後再進行統合分析，共有1,229 位病人之資料進行統合分析，發現SRM可改善PFR增加氧合，其綜合效量為55.63（95%CI [44.92, 66.33]）。依據研究結果應用於個案，住院第二天在壓力控制模式下執行一次SRM，當驅動壓力15 cmH2O，呼氣末正壓從10 cmH2O開始調升，每40秒增加5 cmH2O，並追蹤個案之動脈血氧，其PFR由174上升至318 mmHg，最終成功脫離呼吸器。因此，建議使用呼吸器之ARDS病人，若肺保護通氣策略下仍有嚴重低血氧時，可以考慮執行SRM來增加病人的氧合，進而讓病人能盡早脫離呼吸器。</p> <p> </p><p>Acute Respiratory Distress Syndrome is a highly fatal emergency. Severe dyspnea could lead to a re-spiratory crisis. The author provided care for a 67-year-old man who was intubated due to acute respi-ratory failure in November 2020. The ventilation strategies for lung protection strategies (LPS) were not as effective as expected. Even when using the extracorporeal membrane oxygenation (ECMO) life support system, hypoxemia still presented and deteriorated rapidly. This incident gave the author the motivation to solve this medical dilemma. An evidence-based approach was adopted to assess the ef-fectiveness of the staircase recruitment maneuver for oxygenation. The clinical treatment using PICO interpretations are as follows P: Acute respiratory distress syndrome (ARDS), I: Staircase recruitment maneuver (SRM), C: Usual care, O: PaO2/FiO2 ratio (PFR). Databases such as Cochrane Library, PubMed, CINAHL, and Airiti Library were searched. Five randomized controlled trial studies that met the screening criteria were included, and a meta-analysis was conducted after a systematic review. A total of 1,229 patients were analyzed in the meta-analysis, which showed that SRM can improve PFR and increase oxygenation. The effect size was 55.63 (95% CI [44.92, 66.33]). According to the re-search results applied to this case, SRM was performed in pressure control mode on the second day of hospitalization. When the driving pressure was set at 15cmH2O, the positive end-expiratory pressure (PEEP) was titrated from 10cmH2O, increasing by 5cmH2O every 40 seconds. Tracing the patient’s arterial blood oxygenation, the PFR increased from 174 to 318 mmHg, and the patient was successful-ly weaned from the ventilator. Therefore, ventilators are recommended for ARDS patients with severe hypoxemia under LPS. SRM maybe considered to improve the patient’s oxygenation, allowing for ear-ly weaning from the ventilator.</p> <p> </p>

An Ethics of Justice in Elderly Care: Ageism and the Covid-19 Pandemic.

The study looks into the condition of elderly Covid-19 patients regarding the kind of attention they received during the pandemic given the scarcity of medical resouces in the countries mentioned in this investigation. In this case, we apply the bioethical principle of justice on the age-based criteria in determining which patient must receive treatment The argument is that the same is a form of discimination against the elderly. The purpose of this study is to emphasize that the age-based criteria in deciding whether to treat elderly Covid-19 patients or not is violative of the bioethical principle of justice since it discriminates against them. This study uses the interpretive method. The authors analyzed the literature and the arguments pertaining to the issue of ageism at the height of the Covid-19 Pandemic. We mentioned the countries where the issue of prioritization was a big concern. The qualitative analysis in this paper is meant to respond to such medical dilemma. In our analysis, we determined that when age is used as a criterion, it violates the bioethical principle of justice. The principle is meant to ensure that physicians are fair in dealing with patients. Using age in deciding whether a life is worth saving or not is a prejudice against old people who require care and attention. Medical doctors must treat patients equally and without bias. The challenge, however, is that due to the unprecedented nature of the pandemic, a triage is put in place to be able to manage the overwhelming influx of Covid-19 patients. Some age-based medical treatment criteria that recommend age-based cutoffs for specific treatments are morally untenable.This is because the same is bereft of any acceptable justification that warrants the judgment that the elderly must have less priority when medical resources are scarce. In conclusion, doctors must not discriminate patients on the basis of age. All lives are equal in moral worth. We argue that governments must promulgate non-discriminatory policies when it comes to medical treatment during a global public health emergency.

Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts.

This narrative review article comprehensively explores the multifaceted landscape of social egg freezing, delving into its medical, ethical, societal, psychological, legal, and cultural dimensions. Oocyte cryopreservation, a developing procedure, gives women the chance to match their life goals with fertility goals. Informed decision-making, morally sound guidance, and open communication are all stressed by ethical considerations. Family planning practices, workplace cultures, and gender equality all have an impact on societal dynamics. The process's emotional toll and associated coping mechanisms are highlighted by psychological elements. Legal and policy frameworks need constant ethical reflection and understanding of the regulatory environment. Religious and cultural views highlight the variety of perspectives that influence attitudes toward this practice. For responsible practice to ensure individual liberty while navigating the evolving landscape of reproductive options, it is essential to comprehend how these aspects interact.

Ethical Issues and Distressing Aspects Regularly Faced by Healthcare Professionals in the Care of Pediatric Cancer Patients in Indian Context: A Narrative Review from a Bioethics Consortium

Abstract Caring for children affected by cancer presents one of the most challenging situations for both family members and healthcare workers. Treating children is highly complicated compared to adult patients because they do not understand the severity of the ailment, inability to make educated judgments, and tendency to experience pain during procedures and treatment, and require significant emotional support. Furthermore, cancer treatment is often prolonged and expensive, affecting families both psychologically and financially. In such circumstances, healthcare providers bear the responsibility to provide optimal treatment while also addressing the stress and suffering of both the patient and the caregivers. Pediatric oncology healthcare workers are often exposed to a range of medical and non-medical ethical dilemmas, including breaking bad news, obtaining assent and informed consent, managing financial toxicity, addressing oncofertility concerns, managing treatment-induced long-term side effects, and handling end-of-life issues, all of can be highly challenging. Moreover, the resolution of these processes can be complex, often leaving healthcare workers with more questions than answers. There are very few articles addressing the moral issues faced by healthcare workers treating children affected by cancer in India. This review, based on 12 years of work by the Bioethics Consortium, addresses the most commonly encountered clinical aspects in Indian clinics and aims to contribute to the development of teaching and training of healthcare students and professionals.

A novel approach to place an adult-size stent to treat coarctation of the aorta using small introducers: "Nijres technique".

Aortic arch stent placement in young children is a medical dilemma. This is attributed to the critical lack of commercially available stents that can be delivered through small sheaths and yet have the potential to be dilated to the adult-size aorta. Here in, we describe an innovative first-in-human technique that allows for overcoming the aforementioned challenges. A Palmaz Genesis XD stent was placed to treat coarctation of the aorta in two young children through small-bore sheaths.

Participation, challenges and needs in children with down syndrome during cancer treatment at hospital: a qualitative study of parents' experiences.

Studies report that it can be challenging to assess and treat side-effects and symptoms among children who have impairments and difficulties in expressing their needs. Children with Down syndrome have an increased vulnerability and an increased risk for contracting leukaemia. There is sparse knowledge about the parental experience of how treatment and side-effects affect children with Down syndrome with leukaemia, as well as the role of participation during treatment. This study aimed to explore the perceptions of parents of children with Down syndrome and leukaemia regarding their child's treatment, side effects and participation during hospital care. A qualitative study design was used, and interviews were conducted with a semi-structured interview-guide. Fourteen parents of 10 children with Down syndrome and acute lymphoblastic leukaemia from Sweden and Denmark, 1-18 years of age, participated. All children had completed therapy or had a few months left before the end of treatment. Data was analysed according to qualitative content analysis. Four sub-themes were identified: (1) Continuously dealing with the child's potential susceptibility; (2) Confidence and worries regarding decisions related to treatment regulation; (3) Challenges in communication, interpretation, and participation; and (4) Facilitating participation by adapting to the child's behavioural and cognitive needs. The sub-themes were bound together in an overarching theme, which expressed the core perception "Being the child's spokesperson to facilitate the child's participation during treatment". The parents expressed this role as self-evident to facilitate communication regarding the needs of the child, but also regarding how the cytotoxic treatment affected the vulnerable child. Parents conveyed the struggle to ensure the child's right to receive optimal treatment. The study results highlight parental challenges regarding childhood disabilities and severe health conditions, as well as communication and ethical aspects regarding to act in the best interests of the child. Parents played a vital role in interpreting their child with Down syndrome. Involving parents during treatment enables a more accurate interpretation of symptoms and eases communication and participation. Still, the results raise questions regarding issues related to building trust in healthcare professionals in a context where medical, psychosocial and ethical dilemmas are present.

Court Rulings Complicate Decisions for Pregnant Patients.

Recent legislation restricting or eliminating access to abortion in many states intensifies the challenges faced by pregnant women with cancer, according to experts who spoke during the Presidential Select Symposium: Pregnancy and Cancer at the American Association for Cancer Research Annual Meeting 2023. The emerging legal landscape also presents medical, moral, and ethical dilemmas for physicians when discussing pregnancy termination as an option in high-risk situations.

Delayed cancer diagnosis in the pregnant patient: navigating a complex medical and ethical dilemma.

Prompt diagnosis of cancer in pregnancy is necessary to ensure timely management and improve outcomes. However, there are a several reasons why diagnosis may be delayed in pregnancy. Three major contributors to delayed diagnosis and treatment are patient delay, provider delay, and referral delay. This article aims to (1) increase physician awareness of this problem by providing a detailed review of the main culprits of delayed diagnosis and treatment of cancer in the pregnant patient, (2) discuss the complex ethical issues at hand in these cases, and (3) provide suggestions on how to better address such cases with the goal of improving patient outcomes.

Preparing Future Doctors for Palliative and End of Life Care in Kenya: Cross-sectional Survey

Purpose: The main aim of this study was to assess how prepared are Kenyan doctors in delivering palliative and end of life care to chronic and life-threatening conditions.
 Methodology: Cross-sectional survey was used to assess doctor’s palliative and end of life practices. Multi-center (three-mission referral and teaching hospitals in Kenya): Tenwek, Kijabe, and Chogoria were used to collect data from 96 medical practioners. Medical doctors with at least 6 months managing patients with chronic conditions (cancer, HIV/AIDS and other life-threatening conditions) were recruited into the study. The quantitative data was analysed using an independent t-test. All ethical considerations were addressed.
 Findings: Majority of doctors interviewed were generalists who had managed chronic diseases. Majority had basic concepts of palliative care and end of life care. Those who had received prior training in palliative care were better in performance’s score on knowledge questions regarding palliative care and end of life. Medical doctors were knowledgeable on psychological distress and opioids effects domains as compared to delirium and dyspnea domains. Among those who were knowledgeable in palliative care and end of life care were doctors trained outside Kenya, those who were senior with more experiences (>10 years), over 40 years and had further training after their undergraduate
 Unique Contribution to Theory, Practice and Policy: This study seeks to develop training tailored to Kenyan doctors and Physicians on end-of-life care practices in selected counties then roll-out to the rest of the counties in the country in collaboration with Ministry of Health Kenya and also provide opportunities for doctors to develop palliative and end-of-life care skills especially for resident and junior doctors. This study will also form basis for policy development on palliative and end-of-life care practices in Kenya, which currently is non-existent. End-of-life care Policy would aid in clinical application of good practices surrounding palliative and end-of-life care which should be implemented in Kenya. This study advocates inclusion of end-of-life care training modules in a standardized curriculum for undergraduate as part of training and preparing future Kenyan doctors. Further, this study can be considered as current Physician’s approach to end-of-life care practices in Kenya which then can be a basis to develop guidelines and standards addressing end-of-life which is fraught with ethical and medical dilemmas carried by healthcare professionals.