Exploring the Challenges of Providing and Utilizing Palliative Care for Older Adults with Cancer in South East Nigeria: Insights from Healthcare Professionals

Background: Palliative care remains a critical part of healthcare delivery because of its role in improving the quality of life of individuals diagnosed with life-threatening diseases such as cancer. However, the delivery and utilization of palliative care services in low-income settings like Nigeria face numerous systemic, economic, and sociocultural challenges, necessitating a robust understanding of these challenges and possible solutions. The study explored the challenges of providing and utilizing palliative care for older adults with cancer in southeast Nigeria, from the perspective of healthcare professionals. The study’s research question is focused on identifying these barriers and proposing strategies to address them.

Methods: Qualitative data was obtained using semi-structured interviews from two selected hospitals in Enugu state, Nigeria. Using in-depth interviews, data was obtained from healthcare professionals (n=20) with expertise in oncology, geriatrics and family medicine which was conducted via Zoom. With a focus on the participants’ experiences and perceptions, the interpretive phenomenological analysis was employed to analyze the data. Themes, patterns, and sub-themes were identified with the use of inductive thematic analysis.

Results: Four key themes emerged from the analysis, reflecting the challenges associated with palliative care in Nigeria, including potential solutions for mitigating these challenges and improving access to palliative care in Nigeria. Firstly, participants highlighted the limited resources available for providing palliative care, including inadequate facilities and a shortage of trained professionals. Secondly, the influence of religious and cultural beliefs on patients' attitudes towards medical care was a significant barrier, with many prioritizing spiritual interventions over medical treatments. Thirdly, the study revealed the tendency of cancer patients to present late in hospitals due to seeking spiritual remedies first, leading to delayed diagnosis and treatment. Lastly, the study underscored the critical need for comprehensive training programs for healthcare professionals in palliative care and the importance of public awareness campaigns to dispel misconceptions and promote acceptance of palliative care.

Implications: The study findings highlight the need to address the challenges to accessing and utilizing palliative care in Nigeria, especially for older adults with cancer. The strategies essential for overcoming these barriers include improving the training of healthcare practitioners in palliative care, increasing public awareness, and engaging religious leaders as major stakeholders in timely medical interventions and implementation of responsive healthcare policies. The study emphasizes the significance of a holistic approach to palliative care that acknowledges cultural values and practices while ensuring timely palliative care for older adults with cancer. These findings have significant implications for practice, policy, and further research in the field of palliative care, especially in regions where cultural factors strongly influence healthcare decision-making.