Communication at the end-of-life among advanced cancer patients in Ghana: what patients have to say

Abstract

Individuals with life-limiting illnesses require information and good communication throughout their illness. Effective end-of-life communication (EOLC) improves patients' understanding of their condition, care, and treatment choices, and facilitates informed involvement in decision making at the end-of-life. Studies on patients' experiences with end-of-life (EOL) care and communication in low- and middle-income countries, such as Ghana, are lacking. The objective of this descriptive phenomenological study was to describe the Ghanaian advanced cancer patients' experiences when interacting with the palliative care team about end-of-life care and decisions. Thirteen advanced cancer patients were purposively interviewed. Data was analyzed using a modified version of Colaizzi's method for qualitative data analysis. Nine major themes emerged from the analysis: Breaking of bad news, reaction to cancer diagnosis, fears and worries, managing physical symptoms, EOL discussions, economic burden of cancer diagnosis, culture of optimism, preparing for EOL, and attitude towards death. The lack of EOL communication affected participants QOL. Financial burden of cancer diagnosis was a significant problem for participants, because they could not work and there was no social safety net available in the system for them to use. Lack of available, accessible, and affordable healthcare led to the use of herbal medicine as first line of treatment Culture and religion profoundly impacted the EOL discussions, and there was no culturally appropriate EOL communication guidelines. Findings from this study has provided information for HCPs to use as a guide to design strategies to use when interacting with advanced patients at the EOL to enhance quality of life.