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Effect of Palliative Care Education on Knowledge of Palliative Care among Family Caregivers in Nigeria

Abstract

Palliative care is an important component of comprehensive healthcare for people living with serious and life-limiting illnesses. It aims to improve quality of life by addressing pain, other physical symptoms, psychological distress, social needs, spiritual concerns, and the needs of patients and their families. In Nigeria, family members often provide substantial care for patients with cancer, advanced chronic diseases, neurological conditions, HIV-related illnesses, and other serious health conditions, yet many family caregivers may have limited knowledge of palliative care services, symptom management, psychosocial support, referral pathways, and available healthcare resources. Limited awareness may contribute to delayed use of palliative care, inadequate symptom management, caregiver distress, and unnecessary hospital visits. Palliative care education provides an opportunity to improve caregivers' understanding of palliative care and their ability to recognize when supportive and end-of-life care services may be appropriate. Against this background, this study investigates the effect of palliative care education on knowledge of palliative care among family caregivers in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Health Literacy Framework. The Health Belief Model explains how caregivers' perceptions of the seriousness of patients' illnesses, perceived benefits of palliative care, perceived barriers, and cues to action may influence their understanding and use of palliative care services. Social Cognitive Theory explains how caregivers may acquire palliative care knowledge and skills through education, observation, modelling, practice, feedback, and self-efficacy. The Health Literacy Framework emphasizes caregivers' ability to access, understand, evaluate, and apply health information to make appropriate decisions concerning patients' care. Collectively, these theoretical perspectives provide a suitable framework for explaining how palliative care education may influence knowledge of palliative care among family caregivers 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 who provide unpaid care to family members living with serious or life-limiting illnesses in selected Nigerian communities and healthcare facilities. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, hospitals, palliative care centres, and eligible caregivers. Palliative care education will be assessed using indicators such as frequency and duration of educational sessions, education on the principles of palliative care, pain and symptom management, medication use, nutrition and hydration, psychosocial support, communication, advance care planning where appropriate, end-of-life care, caregiver self-care, available palliative care services, referral procedures, and sources of professional support. Knowledge of palliative care will be assessed using indicators such as understanding of the purpose of palliative care, appropriate timing of palliative care, symptom management, pain management, psychosocial support, spiritual and family support, misconceptions about palliative care, differences between palliative and curative care, available services, referral pathways, and the role of family caregivers. Data will be collected using structured questionnaires, standardized palliative-care knowledge assessment tools, caregiver education records, healthcare facility records, and relevant palliative care programme documents. Descriptive statistics will be used to summarize participants' characteristics, caregiving responsibilities, exposure to education, and palliative care knowledge scores. 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 effect of palliative care education on caregivers' knowledge. Where a quasi-experimental design is adopted, knowledge scores before and after the educational intervention may be compared with those of a comparison group 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 palliative care education has a significant positive effect on knowledge of palliative care among family caregivers in Nigeria. Caregivers exposed to structured palliative care education are expected to demonstrate greater understanding of the principles and benefits of palliative care than caregivers without comparable exposure. Education may improve caregivers' ability to recognize symptoms requiring professional attention, understand appropriate pain and symptom-management strategies, identify available palliative care services, and seek timely assistance from healthcare professionals. It may also correct misconceptions that palliative care is only appropriate during the final days of life or that accepting palliative care means abandoning active medical treatment. Improved knowledge may strengthen communication between caregivers, patients, and healthcare providers and help caregivers participate more effectively in care planning. However, low literacy, cultural and religious beliefs, limited access to palliative care specialists, financial constraints, caregiver burden, inadequate educational materials, and limited availability of palliative care services may reduce the effectiveness of education. The study therefore expects accessible, culturally appropriate, practical, and continuous palliative care education to contribute significantly to improved knowledge among family caregivers in Nigeria. The study is expected to contribute to the literature on palliative care, caregiver education, family caregiving, health literacy, chronic illness management, end-of-life care, supportive healthcare, patient-centred care, 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, hospitals, palliative care centres, oncology services, healthcare professionals, community health workers, caregiver organizations, civil society organizations, development partners, and policymakers regarding strategies for strengthening family caregiver support. The study will also provide evidence-based recommendations for integrating palliative care education into hospital discharge planning and community health programmes, developing culturally appropriate caregiver education materials, strengthening referral pathways to palliative care services, training healthcare professionals to provide caregiver education, expanding community-based palliative care education, and improving access to supportive services for families caring for people with serious and life-limiting illnesses across Nigeria.

Keywords: Palliative care education, palliative care knowledge, family caregivers, caregiver education, serious illness, end-of-life care, health literacy, supportive healthcare, Nigeria, public health.