Experiences of Adult Informal Caregivers in Palliative Care Provision for Persons with Advanced Cancer: A Meta-synthesis.

Abstract

Cancer diagnoses are increasing in Sub-Saharan Africa. Diagnoses often occur at a late stage in the disease, hampering the timely initiation of palliative care. The lack of formalized palliative care provision in the region results in informal caregivers assuming most of the caregiving roles for patients. This has considerable implications for informal caregivers. This meta-synthesis seeks to explore how informal caregivers of persons living with advanced cancer have experienced palliative care provision in Sub-Saharan Africa. This study was guided by Hannes' framework of meta-synthesis. A systematic search of MEDLINE, EMBASE, PsycInfo, Global Health, CINAHL, Web of Science, Scopus, and the Africa Index Medicus databases was conducted. Two authors independently performed the screening and extraction processes. Thematic synthesis guided the analysis and synthesis. Fifteen studies were retained in the study. The synthesis yielded eight analytical themes: motivations for caregiving, roles of informal caregivers, challenges and barriers of informal caregiving, quality of informal caregiving, burden and price of informal caregiving, coping strategies of informal caregivers, recommendations for improving caregiving, and the paradox of end-of-life preparation and advanced planning. In Sub-Saharan Africa, informal caregivers provide the backbone of palliative care, often without preparation, resources, or formal support. Their roles are shaped by cultural expectations of family duty but constrained by poverty and limited health infrastructure. Strengthening caregiver training and integrating their contributions into developing formal palliative care systems are essential to improve outcomes for patients and families.