Barriers to Palliative Care for Terminally Ill Children in a Developing Country Cancer Hospital: A Qualitative Study

Pediatric palliative care (PPC) aims to improve the quality of life for children with life-limiting illnesses and support their families by addressing physical, psychological, social, and spiritual needs. Globally, significant barriers to PPC delivery include limited integration into health systems, inadequate provider training, restricted access to pain medications, and communication challenges. These issues are particularly pronounced in low- and middle-income countries, where cultural, infrastructural, and resource constraints further complicate care. Despite growing recognition of PPC's importance, there is limited understanding of the experiences of children, families, and healthcare providers in these contexts. This study explores barriers to PPC provision in a developing-country cancer hospital, highlighting context-specific challenges and opportunities for improvement.

A retrospective qualitative content analysis of clinical documentation was conducted for 150 pediatric patients (≤18 years) referred to the palliative medicine team at a tertiary care cancer hospital between 1st January 2019 and 27th August 2024, at which point thematic saturation was achieved. Clinical notes were analyzed using Braun and Clarke's thematic analysis framework and coded in NVivo 15. Key themes and subthemes emerged. Ethical approval was obtained from the Institutional Review Board.

Five themes were identified as challenges in palliative care provision to children. These were barriers to effective care, psychological and family-related challenges, impact on quality of life, financial constraints and resource limitations, medical adherence, and treatment non-compliance.

These findings underscore the urgent need to address multifaceted medical, psychosocial, and socioeconomic challenges to pediatric palliative care in developing countries. Prioritizing a multidisciplinary approach, raising awareness, expanding access to pain management, and reinforcing psychosocial support are imperative steps. Through concerted efforts, the quality of life for children with life-limiting illnesses and their families can be meaningfully improved.