Barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in Nigeria: a qualitative formative study
Abstract Background Palliative care (PC) is critical for improving the quality of life for individuals with life-limiting illnesses, yet it remains inaccessible or underdeveloped in low- and middle-income countries like Nigeria. Understanding the factors influencing PC implementation is a crucial fi...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12913-025-13138-1 |
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| author | Chisom Obiezu-Umeh Ann Abiola Ogbenna Lyra S. Johnson Matthew T. Caputo Lisa R. Hirschhorn Tonia Chinyelu Onyeka Akinwale Mukaila Oyegbade Geraldine Ugochinyere Ndukwu Israel Kayode Kolawole Ayilara Saheed Alao Gracia Ker Eke Nadia Adjoa Sam-Agudu Ashti Doobay-Persaud |
| author_facet | Chisom Obiezu-Umeh Ann Abiola Ogbenna Lyra S. Johnson Matthew T. Caputo Lisa R. Hirschhorn Tonia Chinyelu Onyeka Akinwale Mukaila Oyegbade Geraldine Ugochinyere Ndukwu Israel Kayode Kolawole Ayilara Saheed Alao Gracia Ker Eke Nadia Adjoa Sam-Agudu Ashti Doobay-Persaud |
| author_sort | Chisom Obiezu-Umeh |
| collection | DOAJ |
| description | Abstract Background Palliative care (PC) is critical for improving the quality of life for individuals with life-limiting illnesses, yet it remains inaccessible or underdeveloped in low- and middle-income countries like Nigeria. Understanding the factors influencing PC implementation is a crucial first step toward strengthening health system readiness and responsiveness to meet the growing demand for PC services in Nigeria and similar settings. Methods We conducted five in-depth interviews and ten focus group discussions to explore health provider, patient and caregiver perspectives on barriers and facilitators to PC implementation at five geographically diverse PC units in Nigeria. Guided by the Consolidated Framework for Implementation Research (CFIR), qualitative data were analyzed using the framework approach. Results Barriers and facilitators spanned all five CFIR domains (Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process). Barriers to PC implementation included, (1) patient financial constraints, (2) inadequate facility funding and resources, (3) shortage of PC providers, 4) delayed/late referrals, 5) Inaccurate knowledge and negative beliefs about PC among health providers and patients, and (6) substandard opioid medications. Facilitators included, (1) high value for PC among patients and caregivers, (2) positive attitudes and (3) desire for PC knowledge and training among PC providers, (4) strong provider motivation and commitment to improve patient quality of life. Conclusions Our study identified key multi-level factors influencing PC implementation at PC centers in Nigeria. These findings will inform the expansion and integration of PC services into local health systems across Nigeria. |
| format | Article |
| id | doaj-art-fb84d82dcb4a435890a230b39687008e |
| institution | DOAJ |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-fb84d82dcb4a435890a230b39687008e2025-08-20T03:04:23ZengBMCBMC Health Services Research1472-69632025-07-0125111010.1186/s12913-025-13138-1Barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in Nigeria: a qualitative formative studyChisom Obiezu-Umeh0Ann Abiola Ogbenna1Lyra S. Johnson2Matthew T. Caputo3Lisa R. Hirschhorn4Tonia Chinyelu Onyeka5Akinwale Mukaila Oyegbade6Geraldine Ugochinyere Ndukwu7Israel Kayode Kolawole8Ayilara Saheed Alao9Gracia Ker Eke10Nadia Adjoa Sam-Agudu11Ashti Doobay-Persaud12Department of Medical Social Sciences, Northwestern University Feinberg School of MedicineDepartment of Haematology and Blood Transfusion, College of Medicine, University of LagosCenter for Global Health Education, Robert J. Havey, Institute for Global Health, Northwestern University Feinberg School of MedicineCenter for Global Health Education, Robert J. Havey, Institute for Global Health, Northwestern University Feinberg School of MedicineDepartment of Medical Social Sciences, Northwestern University Feinberg School of MedicineDepartment of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of NigeriaHospice & Palliative Care Department, College of Medicine, University of IbadanDepartment of Family Medicine, University of Port-Harcourt Teaching HospitalDepartment of Anaesthesia, University of IlorinDepartment of Pain and Palliative Medicine, Federal Medical CenterDepartment of Paediatrics, University of Port-Harcourt Teaching HospitalInternational Research Center of Excellence, Institute of Human Virology NigeriaCenter for Global Health Education, Robert J. Havey, Institute for Global Health, Northwestern University Feinberg School of MedicineAbstract Background Palliative care (PC) is critical for improving the quality of life for individuals with life-limiting illnesses, yet it remains inaccessible or underdeveloped in low- and middle-income countries like Nigeria. Understanding the factors influencing PC implementation is a crucial first step toward strengthening health system readiness and responsiveness to meet the growing demand for PC services in Nigeria and similar settings. Methods We conducted five in-depth interviews and ten focus group discussions to explore health provider, patient and caregiver perspectives on barriers and facilitators to PC implementation at five geographically diverse PC units in Nigeria. Guided by the Consolidated Framework for Implementation Research (CFIR), qualitative data were analyzed using the framework approach. Results Barriers and facilitators spanned all five CFIR domains (Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process). Barriers to PC implementation included, (1) patient financial constraints, (2) inadequate facility funding and resources, (3) shortage of PC providers, 4) delayed/late referrals, 5) Inaccurate knowledge and negative beliefs about PC among health providers and patients, and (6) substandard opioid medications. Facilitators included, (1) high value for PC among patients and caregivers, (2) positive attitudes and (3) desire for PC knowledge and training among PC providers, (4) strong provider motivation and commitment to improve patient quality of life. Conclusions Our study identified key multi-level factors influencing PC implementation at PC centers in Nigeria. These findings will inform the expansion and integration of PC services into local health systems across Nigeria.https://doi.org/10.1186/s12913-025-13138-1Palliative careQualitative content analysisImplementation scienceConsolidated framework for implementation researchNigeria |
| spellingShingle | Chisom Obiezu-Umeh Ann Abiola Ogbenna Lyra S. Johnson Matthew T. Caputo Lisa R. Hirschhorn Tonia Chinyelu Onyeka Akinwale Mukaila Oyegbade Geraldine Ugochinyere Ndukwu Israel Kayode Kolawole Ayilara Saheed Alao Gracia Ker Eke Nadia Adjoa Sam-Agudu Ashti Doobay-Persaud Barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in Nigeria: a qualitative formative study BMC Health Services Research Palliative care Qualitative content analysis Implementation science Consolidated framework for implementation research Nigeria |
| title | Barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in Nigeria: a qualitative formative study |
| title_full | Barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in Nigeria: a qualitative formative study |
| title_fullStr | Barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in Nigeria: a qualitative formative study |
| title_full_unstemmed | Barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in Nigeria: a qualitative formative study |
| title_short | Barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in Nigeria: a qualitative formative study |
| title_sort | barriers and facilitators to the implementation of palliative care services at five tertiary hospitals in nigeria a qualitative formative study |
| topic | Palliative care Qualitative content analysis Implementation science Consolidated framework for implementation research Nigeria |
| url | https://doi.org/10.1186/s12913-025-13138-1 |
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