PSYCHO-SOCIAL SUPPORTS AND FAMILY INTEGRATION AS DETERMINANTS OF PALLIATIVE CARE OF TERMINALLY-ILL PATIENTS IN UNIVERSITY COLLEGE HOSPITAL, IBADAN NIGERIA
Loading...
Date
2015
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Orthodox medical practice has brought about access to diagnosis and modern healthcare through
the palliative care system to treat the terminally-ill, thereby improving their quality of life. This
treatment of the terminally-ill utilises medical diagnostic interventions with little or no
consideration for psychosocial supports and family integration which are at the core of the
palliative care system. This study, therefore, investigated the psychosocial supports (diversional,
behavioural, emotional, counselling services, companionship, spirituality, rehabilitative supports
and regular visitation) and family integration (financial assistance, life-style modification and re-
allocation of roles) as determinants of palliative care of terminally-ill patients at University
College Hospital, (UCH), Ibadan, Nigeria.
The study adopted the survey research design. The UCH was purposively selected. Proportionate
and stratified random sampling techniques were used to select 587 respondents, namely, 183
health workers (50 doctors, 83 nurses, 24 physiotherapists and 26 social workers), 202
terminally-ill patients and 202 family caregivers from purposively selected eight wards and three
out-patient clinics. Three instruments were used: Psychosocial Support Scale (r=0.67), Family
Integration Scale (r=0.65) and Palliative Care Services Scale (r=0.71). These were
complemented with ten sessions of in depth interview with the health workers, terminally-ill
patients and family caregivers. Two research questions were answered and three hypotheses
tested at 0.05 level of significance. Data were analysed using descriptive statistics, Pearson
product moment correlation, multiple regression and content analyses.
The respondents were 218 male, and 369 female with age of 38.54, ±SD=9.78; with 202
terminally-ill patients; cancer (86), cardiac problems (42), neurological disorders (33), end stage
kidney problems (22) and HIV/AIDS (19). Psychosocial supports and family integration
significantly correlated with palliative care of the terminally-ill (F(12.189)= 25.25, R=.79); and
jointly accounted for 62.0% of the variance in their palliative care. Psychosocial supports (β =
.55) and family integration (β= .51) relatively contributed to the palliative care system.
Components of psychological supports had significant positive relationship with palliative care
as follows: emotional support (r=.69), diversional support (r=.54), behavioural support (r=.50)
and counseling services (r=.45). Also, components of social supports had positive relationship
with palliative care: regular visitation (r=.41), spirituality (r= .33), rehabilitative support (r=
.308) and companionship (r= .066). Observed relationship among family integration factors and
palliative care were: financial assistance (r=.65), life-style modification (r=.32) and reallocation
of roles (r=.32). Problems facing the utilisation of palliative care system include: irregular
training on palliative care for health workers (64.0%), problem of early diagnosis (62.0%), non-
availability of pain control medication (58.2%) and non-affordability of treatment (23.0%).
Patients expressed anxiety over the outcome of illness, difficulty in adaptation to life style
modification and fear of death in the face of poor patient-health workers communication.
Psychosocial support and family integration positively influenced palliative care system for the
terminally-ill patients at the University College Hospital, Ibadan, Nigeria. Therefore, adequate
provision of funds, pain control medication and staff retraining are required to ensure effective
treatment in palliative care. In addition, the terminally-ills and their family members should be
appropriately counselled on the need for life-style modifications and role reallocation.