Organizational models and patient-reported outcomes for palliative care across five tertiary hospitals in Nigeria: An environmental scan

Abstract

Palliative care (PC) is an essential, effective, and affordable component of health care. Global need is rising, with the greatest burden in low-and-middle-income countries. This is especially true in Nigeria where the need is growing rapidly, as are PC services; however, current organizational models have not yet been examined. This was a cross-sectional, descriptive study of five PC sites at tertiary hospitals in four of Nigeria's six geopolitical zones. Surveys, informed by a Centre for Palliative Care, Nigeria (CPCN) needs assessment checklist and the Consolidated Framework for Implementation Research (CFIR), were administered at each site to leadership, frontline workers, patients, and caregivers. Surveys varied by participant group and inquired about organizational models and personal experiences of both providers and recipients of care. Across five sites, there was a total of 282 survey respondents: five leaders, nine frontline workers, 132 patients, and 136 caregivers. The most common diagnoses of PC patients were cancer, sickle cell disease, and HIV. Most sites reported sub-optimal administrative support (80%), hospital management support (60%), and building space (60%). Leadership responses highlighted variations in PC training requirements and opportunities. Frontline workers desired additional training, sponsorship, and governmental support. Most patients and their caregivers reported satisfaction with PC, though high levels of worry and hopelessness were reported. Increased organizational support appears necessary to facilitate improvements in administrative resources, staffing, and training. Emotional and spiritual wellbeing likely require prioritization when designing palliative care delivery services in Nigeria. Further research is needed to refine current services and inform implementation efforts.

Fig 1. Staffing composition and patient volume across five clinical sites.

The chart compares the average number of patients per week (orange bars labeled “PT”) and the total staff composition (stacked bars labeled “Staff”) across five clinical sites. Staff are categorized by professional roles: nurses (yellow), physicians (light green), social workers (brown), pharmacists (mustard yellow), and other personnel (dark green).

Fig 2. Weighted patient-reported outcomes from all clinical sites using the Palliative Outcome Scale (POS).

Responses from 132 patients were aggregated across seven POS items assessing physical, psychological, and emotional well-being over the previous three days. Bars show the distribution of responses rated from 1 to 5. Items cover pain (POS 1), other symptoms (POS 2), worry (POS 3), ability to share feelings (POS 4), sense of life being worthwhile (POS 5), feeling at peace (POS 6), and receiving advice (POS 7). The table below the chart explains each POS item and anchors for Ratings 1 and 5.

Fig 3. Weighted caregiver ratings of Patient-Oriented Scale (POS) items across all sites (N =  136).

The figure displays the distribution of caregiver responses (ratings 1–5) for three key POS items: information provided (POS 8), confidence in caregiving (POS 9), and worry about the patient (POS 10). Percentages indicate the proportion of caregivers selecting each rating category, with higher ratings (e.g., 5) reflecting more positive outcomes. Data are presented as weighted aggregates from all participating sites.