Advance care plans (ACP) for patients is an integral part of End of life care services but very challenging in most African clinical settings. Several factors mitigating against its successful implementation include the culture and communication skills. Discussion around death and dying in most African communities is a taboo and an awkward narratives for the majority of the clinicians with little or no skills to facilitate such discourse.
These challenges were explored among patients suffering from life-limiting illnesses in two Nigeria and South Africa hospitals by surveying the clinicians way of handling the issues and the patients and families attitudes towards ACP.
Methodology A retrospective evaluation of case notes of cancer patients attending FMCAbeokuta, Nigeria were surveyed. A prospective second phase of the study using a questionnaire tool was administered on patients attending both the FMCA and Victoria Hospital Wynberg, Cape Town, South Africa services to explore their experiences and discussion around the ACP.
Results and lessons learnt The FMCA survey revealed none of the reviewed case notes recorded ACP discussion with the patients and if actually done were never documented.The prospective studies further confirmed initiating advance care plan discussion is a big challenge and more daunting process in both African settings. The cultural and incompetent communication skills should be addressed with good public sensitisation and advocacy and also need to empower the clinicians. Mandatory policy that integrates ACP into our routine ‘informed consent’ for all our clinical activities maybe another good option to initiate such discussion with the patients.
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