Figure 1
Program theory of change.
Table 1
Training schedule and learning objectives.
| TOPIC | LEARNING OBJECTIVES |
|---|---|
| DAY 1 | |
| Plenary 1 Elements and Models of Palliative Care | Describe concepts of suffering. Define palliative medicine. Understand the elements of palliative medicine. Distinguish between palliative care and hospice. |
| Plenary 2 Palliative care in Nigeria | Review the history and challenges of palliative care in Nigeria. Describe the status of palliative care in Nigeria. |
| Plenary 3 Legal issues | Describe the legal consensus that has developed for issues in palliative care in Nigeria. Identify which palliative care issues lack legal consensus. Understand common legal myths/pitfalls that can interfere with quality care. |
| DAY 2 | |
| Plenary 4 COVID and Palliative care | Define the goals of palliative care in the setting of COVID-19. Review ethical principles for providing care in a pandemic. Discuss ethics of balancing protection of healthcare workers with caring for patients. Discuss the symptomatic management of COVID-19 & palliative care. |
| Module 1 Communicating bad news | Understand the importance of communication of difficult news as an important and generalizable skill. Apply a six-step protocol for delivering difficult news & clarifying diagnosis & prognosis. Identify difficulties inherent in prognostication. |
| Module 2 Goals of care | Identify ways of discussing hope with patients with serious illness to help frame goals of care. Discuss potential goals of care. Use a framework protocol to negotiate goals of care. Identify goals when patient lacks capacity to make decisions. |
| Module 3 Ethical Issues in End-of-life care: Medical futility | Identify factors that might lead to situations of futility. Understand how to identify common factors. Describe six steps involved in attempting to resolve conflict in futility situations. |
| DAY 3 | |
| Plenary 5 Cancer and palliative care | Describe the burden of cancer and cost to society in Nigeria. Describe the role of palliative care in various cancers in Nigeria. Define the settings in which palliative care in cancer can be practiced. Describe the various complications associated with cancers. Describe an approach to maintaining hope amidst the finality of death. |
| Plenary 6 HIV and palliative care | Discuss the unique needs of patients with HIV/AIDs & palliative care needs. Apply counseling skills in patients with HIV/AIDS & palliative care needs. |
| Module 4 Clinical aspects: Whole patient assessment | Describe concepts of suffering. Identify seven assessment areas during an initial patient encounter. Apply a screening tool to facilitate assessment. |
| Module 5 Pain assessment and management | Compare and contrast nociceptive and neuropathic pain. Identify the steps of analgesic management. Calculate the conversion between different opioids. Explain the use of adjuvant analgesic agents. Recognize the adverse effects of analgesics and their management. |
| Module 6 Psychosocial issues/working with families | Understand and apply a framework for assessing the psychological, social, & spiritual needs of the patient and family facing serious illness and dying. Demonstrate interventions, including the use of family meetings that can be helpful in optimizing communication with patients and their caregivers. |
Table 2
Characteristics of participants (n = 35).
| CHARACTERISTIC | FREQUENCY | PERCENT |
|---|---|---|
| Gender | ||
| Male | 9 | 25.7 |
| Female | 26 | 74.3 |
| Institution | ||
| University of Lagos | 21 | 60.0 |
| University of Ibadan, University College Hospital | 7 | 20.0 |
| University of Jos Teaching Hospital | 3 | 8.6 |
| College of Medicine University of Lagos | 1 | 2.9 |
| Lagos Island Maternity Hospital | 1 | 2.9 |
| Neuropsychiatric Hospital Calabar | 1 | 2.9 |
| Private Hospitals | 1 | 2.9 |
| Profession | ||
| Physicians | 14 | 40.0 |
| Nurse | 10 | 28.6 |
| Pharmacist | 8 | 22.9 |
| Allied Health Professional | 2 | 5.7 |
| Psychologist | 1 | 2.9 |
| Specialty Physicians | ||
| Community Health and Primary Care | 1 | 2.9 |
| Family Medicine | 2 | 5.7 |
| General Practitioner | 2 | 5.7 |
| HIV Medicine | 2 | 5.7 |
| Medical Officer | 1 | 2.9 |
| Obstetrics and gynecology | 3 | 8.6 |
| Palliative Care | 1 | 2.9 |
| Psychiatry | 2 | 5.7 |
| Nurse | ||
| Caregiver | 1 | 2.9 |
| Community Health Nurse Practitioner | 1 | 2.9 |
| Critical care/Infection Prevention and Control | 1 | 2.9 |
| Medical-Surgical Nurse | 1 | 2.9 |
| Midwifery | 1 | 2.9 |
| Nurse clinician | 1 | 2.9 |
| Nurse Educator | 1 | 2.9 |
| Oncology Nurse | 2 | 5.7 |
| Public Health Nurse | 1 | 2.9 |
| Clinical pharmacist | 8 | 22.9 |
| Allied Health Professional | ||
| Acute and critical care physiotherapist | 1 | 2.9 |
| Neurological physiotherapist | 1 | 2.9 |
| Clinical Psychologist | 1 | 2.9 |
| Primary Work Setting | ||
| Teaching Hospital | 30 | 85.7 |
| General Hospital | 2 | 5.7 |
| Private Hospital | 2 | 5.7 |
| Hospice and/or Palliative Care Program | 1 | 2.9 |
| Local of Practice | ||
| Suburban (Town) | 1 | 2.9 |
| Urban | 34 | 97.1 |
| Clinical Population Served | ||
| Adults | 9 | 25.7 |
| Children and Adults | 25 | 71.4 |
| Children, Adults, and Adolescents | 1 | 2.9 |
| Previous Training in Palliative Care | ||
| No | 26 | 74.3 |
| Yes | 9 | 25.7 |
Table 3A
Participant ratings of appropriateness and relevance of training.
| STRONGLY AGREE | AGREE | NEUTRAL | DISAGREE | STRONGLY DISAGREE | |
|---|---|---|---|---|---|
| Relevance to the context that the respondent works in | |||||
| Day 1 | 21 (53.8%) | 17 (43.6%) | 1 (2.6%) | 0 (0.0%) | 0 (0.0%) |
| Day 2 | 16 (66.7%) | 8 (33.3%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) |
| Average score | 19 (60.3%) | 13 (38.5) | 1 (2.6%) | 0 (0.0%) | 0 (0.0%) |
| Appropriateness to the cultural context in Nigeria | |||||
| Day 1 | 16 (41.0%) | 21 (53.8%) | 1 (2.6%) | 1 (2.6%) | 0 (0.0%) |
| Day 2 | 13 (54.2%) | 11 (45.8%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) |
| Average | 15 (46.6) | 16 (49.8 %) | 1 (2.6%) | 1 (2.6%) | 0 (0.0%) |
Table 3B
Participant ratings of how well the training addressed special considerations in Nigeria (n = 28).
| RATING (% OF RESPONDENTS) | ||||
|---|---|---|---|---|
| NOT WELL AT ALL | NOT SO WELL | QUITE WELL | VERY WELL | |
| The special role of women in Nigeria | 39.3% | 17.9% | 28.6% | 14.3% |
| Poverty | 25.0% | 10.7% | 46.4% | 17.9% |
| Children | 35.7% | 10.7% | 50.0% | 3.6% |
Figure 2
Percent of participants who agreed or strongly agreed that Day 1 learning objectives had been met.
Figure 3
Percent of participants who agreed or strongly agreed that Day 2 learning objective had been met.
Table 4
Survey data on the impact of training on palliative care knowledge and skills.
| AGREE STRONGLY | AGREE | NEITHER AGREE OR DISAGREE | DISAGREE | STRONGLY DISAGREE | |
|---|---|---|---|---|---|
| Clearer understanding of the goals of palliative care | 71.4% | 28.6% | 0.0% | 0.0% | 0.0% |
| Expanded knowledge in palliative care | 64.3% | 35.7% | 0.0% | 0.0% | 0.0% |
| Training helped to consolidate existing knowledge about palliative care | 60.7% | 35.7% | 3.6% | 0.0% | 0.0% |
| Feel more empowered as a health care professional as a result of the training | 57.1% | 42.9% | 0.0% | 0.0% | 0.0% |
| Feel more self-confident as a result of the training | 53.6% | 46.4% | 0.0% | 0.0% | 0.0% |
| More comfortable communicating with patients and their families | 67.9% | 32.1% | 0.0% | 0.0% | 0.0% |
| More confident communicating with other health professionals who are involved in providing palliative care | 67.9% | 32.1% | 0.0% | 0.0% | 0.0% |
| More confident in making decisions about how to manage patient care | 57.1% | 39.3% | 3.6% | 0.0% | 0.0% |
| More comfortable in supporting dying patients and their families | 64.3% | 35.7% | 0.0% | 0.0% | 0.0% |
| I will be better able to deal with my own emotions related to providing palliative care | 67.9% | 32.1% | 0.0% | 0.0% | 0.0% |
| I would recommend this training to a colleague | 78.6% | 21.4% | 0.0% | 0.0% | 0.0% |
Figure 4
Pre- and post-training ratings of confidence in providing end of life care (X axis displays number of participants).
Figure 5
Pre- and post-program survey ratings of comfort in prescribing medicines to manage symptoms. (X axis displays number of participants).
Table 5
Pre and post knowledge test scores (n = 20).
| MODULES | PRE-PROGRAM MEAN % CORRECT (S.D) | POST-PROGRAM MEAN % CORRECT (S.D) | p-VALUEa |
|---|---|---|---|
| Day 2: Modules 1, 2, 3 (12 questions)Communication, Goals of Care, Ethical Issues | 55.2% (12.3) | 66.7% (12.7) | 0.001 |
| Day 3: Modules 4, 5, 6 (8 questions)Whole Patient Care, Pain, Psychosocial Issues | 46.6% (17.5) | 57.2% (15.5) | 0.002 |
[i] a Mean pre and percentage correct scores were compared using paired t-test.
Table 6
Participants’ responses to open-ended questions on how the training would impact their professional practice and enable them to address challenges associated with palliative care.
| THEME | ILLUSTRATIVE QUOTES |
|---|---|
| Will be able to provide more holistic care | “To treat the whole patient and not his/her disease only.” “You don’t treat the patient alone but must consider the totality of the patient. That is, physical, psychological, social, spiritual, etc. of the patient.” |
| Gained important communication skills | “It gives me more self confidence in handling palliative care as I will put what I have learned into practice and those tasks that I usually shy away from like breaking unpleasant news can now be done professionally.” “Adoption of the new lessons learnt will be of great help. For example, exploring what the patient knows and understands about his condition before forming goals of care with the patient.” |
| Changes in how they will interact with family members | “In my area of specialty which is oncology the most common problem is issue of fund for treatment it is a relief that the patient does not have to bear this burden alone but can involve the family members.” |
| Increased knowledge about palliative care | “I have more information now about palliative care. The major challenge for me was lack of information especially in the local context.” |
| Increased confidence and sense of empowerment | “The understanding gained during the training, has empowered me to face any palliative care challenge that may arise.” “This training has made me more confident, enlightened and added to my knowledge on patient care.” |
| The need to take a team-based approach to palliative care | “That collaboration or multidisciplinary teamwork is an integral part [of palliative care].” |
| Increased awareness about the gaps in service in Palliative Care in Nigeria | “It has opened my eyes to see the huge gap in the practice of palliative care in Nigeria. I am now better informed and knowledgeable regarding practice of palliative care which has been lacking in my practice.” |
Table 7
Unmet training needs reported by participants.
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