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Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers

BMJ 2003; 326 doi: (Published 15 February 2003) Cite this as: BMJ 2003;326:368
  1. Scott A Murray (Scott.Murray{at}, senior lecturer in general practicea,
  2. Elizabeth Grant, community health adviserb,
  3. Angus Grant, director of medical educationb,
  4. Marilyn Kendall, research fellowa
  1. a Division of Community Health Sciences, University of Edinburgh, Edinburgh EH8 9DX,
  2. b Chogoria Hospital, PO Box 35, Chogoria, Meru, Kenya
  1. Correspondence to: S A Murray
  • Accepted 23 December 2002


Objective: To describe the experiences of illness and needs and use of services in two groups of patients with incurable cancer, one in a developed country and the other in a developing country.

Design: Scotland: longitudinal study with qualitative interviews. Kenya: cross sectional study with qualitative interviews.

Settings: Lothian region, Scotland, and Meru District, Kenya.

Participants: Scotland: 20 patients with inoperable lung cancer and their carers. Kenya: 24 patients with common advanced cancers and their main informal carers.

Main outcome measures: Descriptions of experiences, needs, and available services.

Results: 67 interviews were conducted in Scotland and 46 in Kenya. The emotional pain of facing death was the prime concern of Scottish patients and their carers, while physical pain and financial worries dominated the lives of Kenyan patients and their carers. In Scotland, free health and social services (including financial assistance) were available, but sometimes underused. In Kenya, analgesia, essential equipment, suitable food, and assistance in care were often inaccessible and unaffordable, resulting in considerable unmet physical needs. Kenyan patients thought that their psychological, social, and spiritual needs were met by their families, local community, and religious groups. Some Scottish patients thought that such non-physical needs went unmet.

Conclusions: In patients living in developed and developing countries there are differences not only in resources available for patients dying from cancer but also in their lived experience of illness. The expression of needs and how they are met in different cultural contexts can inform local assessment of needs and provide insights for initiatives in holistic cancer care.


  • Funding These studies were funded in Scotland by a grant from the Chief Scientist Office of the Scottish Executive, and in Kenya by a donation from an Edinburgh patient to Edinburgh University. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests None declared.

  • Ethical approval The Scottish study was approved by the local research ethics committee and trusts. The Kenyan study was approved by the local ethics committee and hospital board of management.

  • Accepted 23 December 2002
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