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Impact of Home-Based Palliative Care Services on Palliative Care Utilization among Patients with Chronic Illnesses in Nigeria

Abstract

Chronic illnesses such as cancer, heart failure, chronic kidney disease, chronic respiratory diseases, advanced neurological conditions, and other long-term health conditions may result in persistent symptoms, functional limitations, psychological distress, and substantial healthcare needs. Patients living with advanced chronic illnesses may require ongoing supportive and palliative care to improve quality of life, manage symptoms, and address psychosocial and family needs. However, access to palliative care services in Nigeria may be limited by inadequate specialized services, geographical barriers, transportation difficulties, financial constraints, limited awareness, and shortages of trained palliative care professionals. Home-based palliative care services provide an approach that brings appropriate supportive care closer to patients and their families, potentially reducing barriers associated with facility-based care and improving continuity of care. Against this background, this study investigates the impact of home-based palliative care services on palliative care utilization among patients with chronic illnesses in Nigeria. The study will be anchored on the Health Systems Framework, Andersen's Behavioral Model of Health Services Use, and the Social Ecological Model. The Health Systems Framework emphasizes service delivery, healthcare workforce, health information, essential medicines and technologies, financing, accessibility, and referral systems as important components of effective palliative care. Andersen's Behavioral Model explains healthcare utilization through predisposing factors, enabling resources, and perceived or evaluated health needs, providing a framework for understanding factors that influence patients' use of home-based palliative care services. The Social Ecological Model emphasizes the interaction of individual, family, community, healthcare, geographical, and broader environmental factors in determining access to and utilization of palliative care. Collectively, these theoretical perspectives provide a suitable framework for explaining how home-based palliative care services may influence palliative care utilization among patients with chronic illnesses in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above diagnosed with selected chronic illnesses and receiving care through selected hospitals, primary healthcare facilities, community health programmes, or home-based care services in Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, healthcare facilities, communities, home-care programmes, and eligible patients. Home-based palliative care services will be assessed using indicators such as availability of home visits, frequency of visits, duration of home-care services, symptom assessment, pain management, medication support, nursing care, psychosocial support, caregiver support, healthcare-provider communication, referral services, continuity of care, and availability of essential palliative medicines. Palliative care utilization will be assessed using indicators such as enrollment in palliative care programmes, number and frequency of palliative care visits, home-care visits received, use of pain and symptom-management services, consultations with palliative care professionals, referrals to palliative care services, adherence to scheduled visits, continuity of service use, and patient or caregiver engagement with available palliative care services. Data will be collected using structured questionnaires, patient records, home-care visit registers, palliative care service records, medication records, referral registers, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, disease profiles, home-based service exposure, and patterns of palliative care utilization. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of home-based palliative care services on palliative care utilization. Where a quasi-experimental design is adopted, utilization rates before and after introduction of home-based palliative care services may be compared with those of a comparison group receiving conventional facility-based care to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that home-based palliative care services have a significant positive impact on palliative care utilization among patients with chronic illnesses in Nigeria. Patients with access to structured home-based palliative care are expected to demonstrate greater utilization of palliative care services than patients without comparable access. Home visits may reduce transportation and geographical barriers while allowing healthcare professionals to provide symptom assessment, pain management, medication support, psychosocial care, caregiver education, and referral services within the patient's home environment. Home-based services may also improve continuity of care, particularly for patients with reduced mobility or advanced illness who experience difficulties attending healthcare facilities regularly. Involvement of family caregivers may further support appropriate use of palliative care and facilitate communication between patients and healthcare providers. However, inadequate numbers of trained palliative care personnel, limited availability of essential medicines, transportation challenges for home-care teams, financial constraints, weak referral systems, inadequate programme coverage, and limited awareness of palliative care may reduce effectiveness. The study therefore expects accessible, adequately staffed, well-coordinated, and sustainable home-based palliative care services to contribute significantly to improved palliative care utilization among patients with chronic illnesses in Nigeria. The study is expected to contribute to the literature on home-based palliative care, palliative care utilization, chronic illness management, community-based healthcare, patient-centred care, supportive healthcare services, caregiver support, health service accessibility, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, palliative care programmes, healthcare professionals, community health workers, caregiver organizations, development partners, and policymakers regarding strategies for expanding palliative care access. The study will also provide evidence-based recommendations for integrating home-based palliative care into primary healthcare services, strengthening community-based palliative care teams, improving access to essential palliative medicines, developing sustainable financing mechanisms, strengthening referral and follow-up systems, training healthcare workers in home-based palliative care, and expanding palliative care services to underserved communities across Nigeria.

Keywords: Home-based palliative care, palliative care utilization, chronic illnesses, community-based healthcare, supportive care, home healthcare, patient-centred care, caregiver support, Nigeria, public health.