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Influence of Palliative Care Services on Quality of Life among Patients with Advanced Illnesses in Nigeria

Abstract

Patients living with advanced illnesses often experience a wide range of physical, psychological, social, and emotional challenges that can significantly affect their quality of life. Palliative care is an important component of patient-centred healthcare because it focuses on preventing and relieving suffering and improving the wellbeing of patients and their families throughout the course of serious illness. Palliative care services may include pain and symptom management, psychological support, social and spiritual care, patient and family counselling, medication management, communication regarding treatment preferences, home-based care, and coordination of healthcare services. Quality of life refers to the physical, psychological, social, emotional, and functional wellbeing of patients as perceived within the context of their illness and healthcare needs. In Nigeria, access to palliative care services remains limited by inadequate awareness, shortages of trained palliative care professionals, insufficient availability of dedicated services, limited access to essential medicines for symptom control, financial constraints, weak referral systems, and inadequate integration of palliative care into routine healthcare delivery. These challenges may result in poorly controlled symptoms and reduced wellbeing among patients with advanced illnesses. Improving access to comprehensive palliative care services may therefore enhance symptom control, emotional wellbeing, functional ability, and overall quality of life. Against this background, this study investigates the influence of palliative care services on quality of life among patients with advanced illnesses in Nigeria. The study will be anchored on the World Health Organization's holistic palliative care framework, Donabedian's Structure-Process-Outcome Model, and the Health Systems Framework. The WHO palliative care framework emphasizes early identification and assessment of suffering and the provision of appropriate interventions for physical, psychological, social, and spiritual needs. Donabedian's Model explains how healthcare structures and care processes influence patient outcomes and provides a framework for assessing how the availability and delivery of palliative care services may affect patients' quality of life. The Health Systems Framework emphasizes service delivery, health workforce, essential medicines, health information, financing, and access to healthcare as key components of an effective health system. Collectively, these theoretical perspectives provide a suitable framework for explaining the relationship between palliative care services and quality of life among patients with advanced illnesses in Nigeria. The study will adopt a quantitative cross-sectional research design. Data will be collected from adult patients diagnosed with advanced or life-limiting illnesses receiving care at selected public hospitals, private hospitals, hospices, palliative care centres, and other relevant healthcare facilities across selected locations in Nigeria. A multistage sampling technique will be used to select states, healthcare facilities, palliative care centres, and eligible participants. Palliative care services will be assessed using indicators such as availability of pain management, symptom assessment and control, medication support, psychological counselling, social support, spiritual care, patient and family education, communication about treatment preferences, home-based support, referral services, follow-up care, and availability of trained palliative care personnel. Quality of life will be assessed using an appropriate validated quality-of-life instrument covering relevant domains such as physical functioning, symptom burden, emotional wellbeing, psychological wellbeing, social relationships, daily functioning, and overall perceived quality of life. Structured questionnaires, facility assessment checklists, and relevant clinical records will be used for data collection where appropriate. Descriptive statistics will be used to summarize participants' characteristics, access to palliative care services, and quality-of-life levels. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the influence of palliative care services on quality of life. Diagnostic tests will also be conducted to assess the reliability of the research instruments and the robustness of the findings. The study is expected to find that access to comprehensive palliative care services has a significant positive influence on quality of life among patients with advanced illnesses in Nigeria. Patients who receive appropriate and regular palliative care are expected to report better quality of life than patients with limited access to such services. Effective pain and symptom management may reduce physical suffering and improve patients' ability to perform routine activities. Psychological counselling and social support may improve emotional wellbeing and help patients and families cope with the challenges associated with advanced illness. Spiritual support and effective communication may also promote dignity, improve patients' experiences of care, and support healthcare decisions that reflect patients' preferences and needs. Conversely, inadequate palliative care services, shortages of trained personnel, limited access to essential medicines, and weak referral systems may contribute to uncontrolled symptoms and poorer quality of life. However, palliative care services alone may not fully determine quality of life because disease severity, socioeconomic circumstances, family support, treatment burden, healthcare costs, and access to other healthcare services may also influence patients' wellbeing. The study is expected to contribute to the literature on palliative care, quality of life, advanced illnesses, patient-centred care, supportive healthcare, oncology, chronic disease management, nursing, community health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospitals, hospices, palliative care providers, healthcare professionals, patient-support organizations, development partners, and policymakers regarding strategies for strengthening palliative care delivery. The study will also provide evidence-based recommendations for expanding palliative care services, increasing the availability of trained palliative care professionals, improving access to essential pain-relief and symptom-control medicines, strengthening referral and follow-up systems, integrating palliative care into routine healthcare services, expanding community and home-based palliative care, and improving support for patients and families affected by advanced illnesses in Nigeria.

Keywords: Palliative care services, quality of life, advanced illnesses, Nigeria, patient-centred care, symptom management, pain management, supportive care, chronic illness, oncology, healthcare services, public health.