Building bridges to care: A co-created community palliative care package for resource-limited settings.

Abstract

Background: Palliative care (PC) needs are substantial in Nigeria, yet access to specialist PC services remains limited, particularly in rural and peri-urban communities.

Objectives: To co-create an implementation-ready, community-delivered PC package for rural Nigerian settings without PC specialists and specify its components, delivery roles, and referral pathways.

Design: Sequential explanatory mixed-methods, participatory co-creation design in which quantitative prioritization informed qualitative refinement.

Methods: Participants (health professionals, traditional and religious leaders, patients, caregivers, advocates, and policymakers) used Mentimeter® to generate and rank feasible non-pharmacologic components, followed by an adapted Group Model Building (GMB) process to identify key health-system and sociocultural determinants, specify the most appropriate delivery settings and cadres, and define delivery processes and referral pathways to basic PC providers at facilities. The process included three pre-workshop virtual sessions (n=51) and a 5-day in-person GMB workshop in Enugu, Nigeria (n=45), with diverse participants from all six geopolitical regions recruited via the ICON-3 Practice-Based Research Network. Outputs were refined through participant validation and technical expert review to enhance feasibility and implementation readiness.

Results: Participants prioritized effective pain and symptom relief, strengthened communication and shared decision-making, intentional engagement of religious leaders, and improved community-primary care collaboration. The resulting package comprises three components (pain and symptom management, psychosocial support, spiritual care) delivered via a hub-and-spoke model in which CHEWs/CHAs serve as community "Anchors," while facility-based basic PC providers and tertiary specialists provide oversight and manage complex cases. Key barriers included limited training and stigma, medication access constraints, and weak referral systems; proposed solutions emphasized training with supportive supervision, improved medicines access/financing and strengthened referral pathways and community support structures.

Conclusion: A participant-designed, task-shared, hub-linked community PC package is feasible in principle for Nigerian settings without PC specialists and provides an implementation-ready blueprint for feasibility testing, adaptation, and scale-up planning.