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Stakeholder perspectives and requirements to guide the development of digital technology for palliative cancer services: a multi-country, cross-sectional, qualitative study in Nigeria, Uganda and Zimbabwe

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Kennedy Bashan Nkhoma, Bassey Ebenso, David Akeju, Samuel Adejoh, Michael Bennett, Mike Chirenje, Adlight Dandadzi, Elizabeth Nabirye, Elizabeth Namukwaya, Eve Namisango, Kehinde Okunade, Omolola Salako, Richard Harding, Matthew J. Allsop

Original languageEnglish
Article number4
JournalBMC Palliative Care
Volume20
Issue number1
Early online date4 Jan 2021
DOIs
Accepted/In press10 Dec 2020
E-pub ahead of print4 Jan 2021
Published4 Jan 2021

Bibliographical note

Funding Information: This work was supported by the Medical Research Council (grant no MR/S014535/1) and Research England Quality-Related Global Challenges Research Fund (QR GCRF) through the University of Leeds. Funding Information: We thank Mr. Olasupo Oyedepo, Director of the African Alliance of Digital Health Networks and Project Director at ICT4HEALTH Project, for guidance on the development and implementation of this project. We also thank Professor Olaitan Soyannwo at the University of Ibadan, Nigeria, Mr. Lovemore Mupaza and Dr. Dickson Chifamba, Island Hospice and Healthcare, Zimbabwe, Dr. Henry Ddungu at Uganda Cancer Institute and Dr. Jack Turyahikayo, Mulago Palliative Care Unit, Uganda, Dr. Emmanuel Luyirika at the African Palliative Care Association Uganda for their help, support and guidance during the delivery of the project. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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Abstract

Introduction: Coverage of palliative care in low and middle-income countries is very limited, and global projections suggest large increases in need. Novel approaches are needed to achieve the palliative care goals of Universal Health Coverage. This study aimed to identify stakeholders’ data and information needs and the role of digital technologies to improve access to and delivery of palliative care for people with advanced cancer in Nigeria, Uganda and Zimbabwe. Methods: We conducted a multi-country cross-sectional qualitative study in sub-Saharan Africa. In-depth qualitative stakeholder interviews were conducted with N = 195 participants across Nigeria, Uganda and Zimbabwe (advanced cancer patients n = 62, informal caregivers n = 48, health care professionals n = 59, policymakers n = 26). Verbatim transcripts were subjected to deductive and inductive framework analysis to identify stakeholders needs and their preferences for digital technology in supporting the capture, transfer and use of patient-level data to improve delivery of palliative care. Results: Our coding framework identified four main themes: i) acceptability of digital technology; ii) current context of technology use; iii) current vision for digital technology to support health and palliative care, and; iv) digital technologies for the generation, reporting and receipt of data. Digital heath is an acceptable approach, stakeholders support the use of secure data systems, and patients welcome improved communication with providers. There are varying preferences for how and when digital technologies should be utilised as part of palliative cancer care provision, including for increasing timely patient access to trained palliative care providers and the triaging of contact from patients. Conclusion: We identified design and practical challenges to optimise potential for success in developing digital health approaches to improve access to and enhance the delivery of palliative cancer care in Nigeria, Uganda and Zimbabwe. Synthesis of findings identified 15 requirements to guide the development of digital health approaches that can support the attainment of global health palliative care policy goals.

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