Barriers to the provision and utilization of palliative care in Africa: A rapid scoping review

systems, especially in Africa. This scoping review synthesized existing published papers on adult PC in Africa, to report the barriers to PC and to assess the methodologies used in these studies. Eight electronic databases and Google Scholar were searched to identify relevant studies published between 2005 and 2018. Overall, 42 publications (34 empirical studies and 9 reviews) that reported issues related to barriers to adult PC were selected. Three themes identified were individual-level, system-level, and relational barriers. The studies reviewed predominantly utilized cross-sectional and retrospective study design, underscoring the need for more studies employing qualitative design. Findings highlight the need for health education, training opportunities, more funding, communication, and timely referral. Future works could focus on underlying factors to these barriers and ethno-religious perspectives to PC in Africa

Psychosocial aspects of adult cancer patients: a scoping review of sub-Saharan Africa

Psychosocial aspects of adult cancer patients in sub-Saharan Africa (SSA) have been described in silos of research articles. Integrative analysis of regional evidence is lacking. This review aimed to describe the scope of existing research on mental health problems, identify research gaps and make informed research, policy and practice recommendations. Search was conducted for original peer-reviewed research articles, irrespective of their quality, on psychosocial aspects of cancer in all SSA countries using PubMed, Google Scholar, Google search, African Index Medicus and direct searches of reference list of pertinent journal articles. Publications in English or translated to English were included. Case reports, dissertations, abstracts, publications without primary focus on psychosocial issues, psychosocial issues in children and studies conducted with SSA populations living outside the sub-region were excluded. The methodological framework described by Arksey and O'Malley was used to synthesize and present the results. Inductive approach was used to arrive at the thematic areas. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline was used to describe the review. Eighty-three studies conducted across 15 countries were identified. Six thematic areas emerged namely; psychosocial needs, psychiatric disorders, coping strategies, suicidality, psychometrics and psychosocial interventions. Fifteen of 46 countries had at least one study with the majority of articles emanating from Nigeria. Research articles on psychosocial needs, psychiatric morbidities and coping strategies appears adequate for systematic review in SSA region. Despite the overwhelming evidence of high unmet psychosocial needs, a huge gap exists regarding psychosocial interventions. Further research is needed into identified gaps in the region and quality of evidence of these studies need to be improved upon. Comprehensive policies and action plan development are sin qua non for addressing psychosocial problems of adults with cancer in SSA.12m embarg

Digital psychiatry in Nigeria: A scoping review

Background: Mental healthcare workforce shortage in Nigeria poses a major obstacle to mental health services scale-up. Digital psychiatry may provide a veritable platform to bridge treatment gaps. Aim: To provide an overview of quantity and range of peer-reviewed publications on digital psychiatry in Nigeria. Setting: A comprehensive literature search encompassed all original, peer-reviewed research articles on digital psychiatry in Nigeria. PubMed, Google Scholar, and a direct exploration of relevant journal article reference lists were utilised. Inclusion criteria covered peer-reviewed original articles conducted in Nigeria between January 2013 and January 2023, regardless of quality. Exclusions comprised case reports, reviews, dissertations, and abstracts. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were adhered to, while methodological framework of Arksey and O’Malley was used to describe the review. Results: Fourteen studies meeting inclusion criteria exhibited two primary research areas: implementation and intervention. Most studies focused on intervention strategies, showcasing efficacy of digital devices in enhancing outcomes in depression and clinic appointments. Implementation studies indicated favorable acceptance by both clients and healthcare practitioners. Conclusion: Digital technology seems acceptable to Nigerian patients and clinicians. Policies to operationalise provision of digital healthcare services will have positive impact in addressing unmet mental health needs. Finally, the quality of the evidence from majority of studies has to be enhanced, and additional studies are required to uncover gaps in some regions of the country. Contribution: This research demonstrates that, despite some drawbacks, digital methods of providing mental healthcare are practical in Nigeria

'Wrong treatment': doctors’ take on medical futility in a low-resource ICU

Background: Health caregivers in Intensive Care Units (ICUs) in developed countries have documented accounts of futile care for patients admitted into the Intensive Care Unit (ICU). But, evidence gaps exist in medical literature from developing countries on futility. While costs of establishing and running ICUs are astronomical in resource-poor countries, administration of medically futile care can further compound problems for ICU patients, family caregivers, health caregivers and hospital establishments. We sought and analysed the opinions of anaesthetists working in ICUs, highlighting the concept of medically futile care as perceived by health caregivers in low-middle income ICUs. Materials & Methods: Using a phenomenological framework, this study involved face-to-face in-depth interviews conducted with 15 resident doctors working in two ICUs of a tertiary health institution in South-East Nigeria. Transcripts were analysed using Interpretive Phenomenological Analysis (IPA). Results: Five core themes emerged: Unnecessary procedures and interventions; intrinsic and extrinsic factors of medically futile care; family caregiver influences; negative notions of medical futility; ICU outcomes. One participant was of the view that not intervening medically might be best for some patients admitted into the ICU. Other participants described cases where patients received care which participants considered futile, noted possible causes of futile treatments and proffered strategies to correct such situations. Conclusion: The surveyed doctors commonly view care to be futile in low-resource ICUs. Several factors are implicated including lack of goals in patient care, poor communication, lack of specialist training in intensive care and lack of protocols. Medical futility, in the opinion of these doctors, may contribute substantially to the challenges of running an ICU. This calls for multiple strategies for its reduction so as to ensure efficient use of scarce resources and improved outcomes in ICUs located in resource-limited settings

'Wrong treatment': doctors’ take on medical futility in a low-resource ICU

Background: Health caregivers in Intensive Care Units (ICUs) in developed countries have documented accounts of futile care for patients admitted into the Intensive Care Unit (ICU). But, evidence gaps exist in medical literature from developing countries on futility. While costs of establishing and running ICUs are astronomical in resource-poor countries, administration of medically futile care can further compound problems for ICU patients, family caregivers, health caregivers and hospital establishments. We sought and analysed the opinions of anaesthetists working in ICUs, highlighting the concept of medically futile care as perceived by health caregivers in low-middle income ICUs. Materials & Methods: Using a phenomenological framework, this study involved face-to-face in-depth interviews conducted with 15 resident doctors working in two ICUs of a tertiary health institution in South-East Nigeria. Transcripts were analysed using Interpretive Phenomenological Analysis (IPA). Results: Five core themes emerged: Unnecessary procedures and interventions; intrinsic and extrinsic factors of medically futile care; family caregiver influences; negative notions of medical futility; ICU outcomes. One participant was of the view that not intervening medically might be best for some patients admitted into the ICU. Other participants described cases where patients received care which participants considered futile, noted possible causes of futile treatments and proffered strategies to correct such situations. Conclusion: The surveyed doctors commonly view care to be futile in low-resource ICUs. Several factors are implicated including lack of goals in patient care, poor communication, lack of specialist training in intensive care and lack of protocols. Medical futility, in the opinion of these doctors, may contribute substantially to the challenges of running an ICU. This calls for multiple strategies for its reduction so as to ensure efficient use of scarce resources and improved outcomes in ICUs located in resource-limited settings

Placing care:The Impact of the Physical Environment on Experiences of Providing and Utilizing Palliative Care

Background: Environmental design in palliative and end-of-life care is known to improve care outcomes, service-user satisfaction, and the continuation of service uptake. No study in the literature has investigated the influence of the environment on palliative and end-of-life care in Nigeria or other African contexts.Purpose: This study was designed to explore the impact of the physical environment (i.e., place and people) on staff and service users and how these influence the experiences of providing and using palliative and end-of-life care in a Nigerian hospital context.Methods: Ethnographic methodology was employed because this approach facilitates understanding of environmental realities. This study is part of a larger ethnographic research project developed to uncover aspects of organizational complexities related to the provision and use of palliative and end-of-life care in the Nigerian context. Three hundred fifty hours of participant observation was achieved, and semistructured interviews were used to gather data from 26 participants, including 10 patients, 11 members of a palliative care team, and five hospital managers. Informal chats and photographic capture were additional methods used in data collection. Thematic analysis was conducted to identify and analyze patterns within the collected data.Results: Physical space, equipment, and placing staff were the three primary themes identified. The physical environment was untidy, and the ward layout prevented privacy, dignity, or comfort for patients and families. The equipment was old and inadequate, and the context of care was worsened by insufficient staffing and neglect of the environmental needs of the staff.Conclusions: Hospital design for palliative and end-of-life care in Nigeria is “autoinhibitory” (a negative feedback mechanism whereby hospital design detracts rather than promote quality of care), and a physical environment that supports the provision and utilization of care must be implemented to promote palliative and end-of-life care success. Urgent policy action is needed to improve environmental and staffing conditions to advance palliative and end-of-life care 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

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 health-care system in Nigeria or other African contexts may be influencing utilization of these services. Aim: This study explored how social complexities and the organization of health-care influenced the decision-making process for the utilization of oncology and PC in a Nigerian hospital. Methods: This qualitative study used an interpretive descriptive design. Data were collected using semistructured interview guides with 40 participants, comprising health-care professionals, patients, and their families. Thematic analysis was conducted to generate and analyze patterns within the data. Findings: Three themes were identified: dysfunctional structural organization of the health-care 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 health care and PC. Conclusion: This article offers insights into the role of the health-care system, as organized currently in Nigeria, as “autoinhibitory” and not adequately prepared to address the increasing burden of cancer. We therefore argue that there is a need to restructure the Nigerian health-care 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