Socio-economic and Socio-cultural Influences on Newly Qualified Physicians’ Preparedness to Practice Palliative Care in Nigeria - A Qualitative Study

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Abstract Background Dealing with life-limiting illnesses, death, dying and grief, is uncharted territory for the fresh medical graduate. It is a field that is heavily influenced by cultural, religio-spiritual and social factors. These add a complexity to palliative and end-of-life-care that challenges newly qualified physicians and requires the formation of appropriate knowledge, skills and attitudes in the junior doctor. This study aimed at obtaining insight into the perspectives and preparedness of newly qualified physicians in Nigeria, regarding the practice of palliative care. Methods The study was a cross-sectional, multicentre survey of newly qualified Nigerian physicians, using semi-structured qualitative interviews. The data was analysed, applying content-structuring qualitative content analysis. Results Forty semi-structured interviews were held with medical House Officers at two Nigerian tertiary institutions. The qualitative content analysis resulted in a comprehensive code system. Palliative care practice as experienced by young physicians in Nigeria was highlighted by four codes: Breaking Bad News; Pronouncing a Prognosis and Diagnosing Dying; Involving the Family and Pain and Symptom Management. Other codes highlighted possible influences on the newly qualified physicians’ palliative care practice. Main themes that were the major influencers here were: socio-economic considerations of a resource-limited setting and cultural-religious aspects characteristic to Nigeria. Conclusions This study offers valuable insight into potential socio-cultural and socio-economic variables on palliative care practice in Nigeria. Evidence on social, cultural and religio-spiritual dimensions of palliative care is indispensable for culturally sensitive care. The results could aid in the development of appropriate knowledge, skills and attitudes in newly qualified physicians through culturally and contextually appropriate palliative care training measures. The results may be applicable to other Sub-Saharan African settings and to African communities in the diaspora and may be used to improve future palliative care practice with a socio-cultural perspective.

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