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 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.