Understanding the organization of hospital-based palliative care in a Nigerian Hospital: An ethnographic study

Abstract

Context:Organization and delivery of palliative care (PC) services vary from one country to another. In Nigeria, PC has continued to develop, yet the organization and scope of PC is not widely known by most clinicians and the public.Objectives:The aim of the study is to identify PC services available in a Nigerian Hospital and how they are organized.Methods:This ethnographic study, utilized documentary analysis, participant observation, and ethnographic interviews (causal chat during observation and individual interviews) to gather data from members of PC team comprising doctors (n = 10), nurses (n = 4), medical social workers (n = 2), a physiotherapist, and a pharmacist, as well nurses from the oncology department (n = 3). Data were analyzed using Spradley's framework for ethnographic data analysis.Results:PC was found to be largely adult patient-centered. A hospital-based care delivery model, in the forms of family meetings, in- and out-patients' consultation services, and a home-based delivery model which is primarily home visits conducted once in a week, were the two models of care available in the studied hospital. The members of the PC team operated two shift patterns from 7:00 am to 2.00 pm and a late shift from 2:00 pm to 7:00 pm instead of 24 h service provision.Conclusions:Although PC in this hospital has made significant developmental progress, the organization and scope of services are suggestive of the need for more development, especially in manpower and collaborative care. This study provided knowledge that could be used to improve the clinical practice of PC in various cross-cultural Nigerian societies and other African context, as well as revealing areas for PC development.

Exploring organizational culture regarding provision and utilization of palliative care in a Nigerian context: An interpretive descriptive study

“…The ranges of PC services rendered in this hospital include pain management, family meetings, bereavement support, counseling, and symptom management. [ 5 ]…”

“…The PC team in the studied hospital consisted of multiprofessionals, specifically, a doctor, four nurses, a physiotherapist, two social workers, and a pharmacist. [ 5 ] This PC team collaborated with professionals from other departments to care for cancer patients, but members of PC team expressed two views about interdepartmental collaboration. First, some departments managed cancer and other patients with life-limiting illnesses without collaborating with them:…”

“…[ 2 3 ] However, PC has continued to be underutilized and not integrated into many of the Nigerian health-care systems, as well as many other African contexts. [ 4 5 ] The 2015 Quality of Death Index shows that Nigeria was ranked the last among other African countries in the area of the palliative and health-care environment, human resources, affordability of care, quality of care, and community engagement. [ 6 ] Several studies have reported inadequate funding, limited availability of morphine, religious and cultural meaning-making, insufficient PC professionals, and inadequate professional and public knowledge of PC to be factors that have impacted on PC development in Nigeria.…”

Social and Health System Complexities Impacting on Decision-Making for Utilization of Oncology and Palliative Care in an African Context: A Qualitative Study

“…Many studies have uncovered obstacles to PC in an African context, such as too few health professionals with PC training and education; lack of training opportunities; poor knowledge of, and attitudes toward, PC; professionals and service-users' lack of awareness; inadequate opioids; lay meaning-making of cancer/care; and a lack of PC policies in most African countries. [4][5][6][7][8][9] The rising costs of chemotherapy, drug resistance, and insufficient radiotherapy machines are some of the recognized challenges of cancer care in poorly resourced countries. 10,11 In addition, patients with cancer experience not only physical problems but also cancer-related social difficulties that impact on their mental health and quality of life.…”

Construction of meanings during life‐limiting illnesses and its impacts on palliative care: Ethnographic study in an African context

“…To date, previous studies indicate that it has steadily improved in the more economically developed countries but has continued to be less available and under‐utilised in low and middle‐income countries, especially in African countries such as Nigeria . There is a growing number of studies indicating that inadequate funding, opioid availability, policy, and education impact on PC, especially in the African context, but there is a paucity of research on how meaning‐making in serious illnesses influences PC.…”