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The influence of socio-cultural and socio-economic variables on the practise of palliative care

The perceived self-efficacy and preparedness of newly qualified physicians in practising palliative care were reported to be higher in areas of family involvement, and pain and symptom management than in areas of breaking bad news, prognosis, and diagnosing dying. Major influences on the young physicians’ perceived self-efficacy and preparedness in practising palliative care were socio-economic circumstances of a resource-limited setting and cultural-religious considerations. In addition, the perceived impact of palliative care education and experience was documented.

Dealing with life-limiting illnesses, death, dying and grief, is uncharted territory for medical graduates. It is a field that is heavily influenced by cultural, religio-spiritual and social factors. This adds complexity to palliative and end-of-life-care, which challenges newly qualified physicians and requires the formation of appropriate knowledge, skills, and attitudes in junior doctors. 

A multicentre cross-sectional survey of newly qualified Nigerian doctors (N=40) was conducted using semi-structured qualitative in-depth interviews with medical GPs at two tertiary institutions in Nigeria. Data were analysed using qualitative content analysis.

The findings show how the challenges of a resource-limited environment and the socio-cultural characteristics of their setting influenced respondents' perspectives, perceived self-efficacy and readiness in the key areas of palliative care. The data highlight the importance of developing and implementing context-appropriate palliative care education and training for newly qualified doctors to provide culturally sensitive, quality palliative care. Emphasis should be placed on communication, and cultural and religious-spiritual understandings of grief, death and dying. Active learning experiences should be prioritised over rigorous classroom lectures and passive, observational learning.

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