Social and health system complexities impacting on decision-making for utilisation of oncology and palliative care in an African context: a qualitative study

David A. Agom (Lead / Corresponding author), Stuart Allen, Sarah Neill, Judith Sixsmith, Helen Poole, Tonia C. Onyeka, Jude Ominyi

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Abstract

Background: There is a dearth of research focusing on identifying the social complexities impacting on oncology and palliative care (PC), and no study has explored how the healthcare system in Nigeria or other African contexts may be influencing utilisation of these services.

Aim: This study explored how social complexities and the organisation of healthcare influenced the decision-making process for the utilisation of oncology and PC in a Nigerian hospital.

Methods: This qualitative study used an interpretive descriptive design. Data was collected using semi-structured interview guides with 40 participants, comprising healthcare professionals, patients and their families. Thematic analysis was conducted to generate and analyse patterns within the data.

Findings: Three themes were identified: dysfunctional structural organisation of the healthcare delivery system; service-users’ economic status; and the influence of social networks. The interrelationship between the themes result in patients and their family members decisions either to present late to the hospital, miss their clinical appointments, or not to seek oncological healthcare and PC.

Conclusion: This paper offers insights into the role of the healthcare system, as organised currently in Nigeria, as ‘auto-inhibitory’ and not adequately prepared to address the increasing burden of cancer. We therefore argue that there is a need to restructure the Nigerian healthcare system to better meet the needs of patients with cancer and their families as failure to do so will strengthen the existing inequalities, discourage usage and increase mortality.
Original languageEnglish
Number of pages7
JournalJournal of Palliative Care
Early online date16 Dec 2019
DOIs
Publication statusE-pub ahead of print - 16 Dec 2019

Keywords

  • Africa
  • Cancer
  • Decision Making
  • Health System
  • Nigeria
  • Oncology
  • Palliative Care
  • Qualitative study
  • Social

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