Feasibility and preliminary effectiveness of a psychosocial intervention on the quality of life of adult Nigerians with cancer and their family caregivers: A multi-method study

Abstract

Nigeria's capacity to treat adults with cancer is limited due to a lack of human resources and medical facilities. Adults diagnosed with cancer rely largely on their family caregivers for support throughout their cancer journey. According to current cancer research, both persons with cancer and their family caregivers report unmet social, spiritual, informational, and psychological needs. Interventions to improve the health-related quality of life of persons with cancer and their family caregivers have been conducted mainly in high-income countries, with limited research in Africa, particularly Nigeria. The purpose of this PhD program of work was to develop and test the feasibility and effectiveness of a psychosocial intervention on the social, spiritual, and informational needs, as well as cancer health literacy and health-related quality of life, of adults living with cancer and their families in Nigeria. The thesis is presented as a series of published and unpublished papers, comprising five sequential studies. A sequential, complementary, multi-method approach was applied, in which data and findings from one study served as the foundation and direction for the next. The Hodge Spirituality Framework and the Supportive Care Model for Cancer Care were used to guide the study. The Spiritual Framework articulates seven distinct explanations for how spirituality promotes health. The Supportive Care Model denotes seven key areas of need to assist in conceptualising what cancer patients require and how service delivery could be planned. Study One was a systematic review of the literature that aimed to determine contextual factors relating to the use of psychosocial support by adults with cancer and their family caregivers. There was a dearth of research on effective psychosocial interventions for cancer patients and family caregivers in low-income countries. The literature review concluded that interventions for adults with cancer and family caregivers in Africa must be conceptually motivated, culturally appropriate, and tailored to meet local needs. A cross-sectional quantitative design was used in Study Two to determine the needs, health literacy, and health-related quality of life of adults with cancer and their family caregivers (n = 240) in Nigeria. Adults living with cancer and their families both had considerable psychosocial needs that adversely affect their health-related quality of life. There were consistent relationships between psychosocial needs, cancer health literacy, and health-related quality of life. The findings underscored the relevance of addressing the psychosocial needs and health literacy of persons living with cancer and their family caregivers. Study Three was the development of an intervention, which was preceded by an exploration of relevant models. The Medical Research Council and Behaviour Change Wheel guided the systematic selection of behaviours to be targeted by the intervention. It was proposed that change was needed in the psychological capability, social opportunity, and automatic and reflective motivation of adults with cancer and their family caregivers. Seven intervention functions and nineteen behaviour change taxonomies were identified as relevant to include in an intervention targeted at meeting needs and improving health-related quality of life. Study Four described the protocol of a randomised controlled trial to test the feasibility and effectiveness of a nurse-delivered psychosocial intervention for adult Nigerians living with cancer and their family caregivers. In Study Five, 176 participants participated in a two-arm randomised controlled trial to assess the feasibility and effectiveness of the intervention. Findings indicated that the program was feasible to implement, and the intervention group demonstrated significant improvements in family/social support, spiritual needs, information needs, cancer health literacy, and health-related quality of life (adults with cancer, F (13, 65) = 24.50, p < 0.001; Wilks’ Lambda = .17; family caregivers, F (13, 65) = 14.27, p < 0.001; Wilks’ Lambda = .26). As evidenced by strong acceptance (86.3%) and retention rates (93.2%), the psychosocial intervention was welcomed by participants. Treatment fidelity ranged from 88.5 to 94.6 percent. This PhD research addressed knowledge gaps about the needs of adults with cancer and their families in Nigeria. It was the first study in Nigeria to employ the Spiritual and Supportive Care Frameworks in an oncology setting and involve participants in the intervention planning process. The study and associated publications contribute to the literature on cancer caregiving and intervention development by describing and specifying the design, content, and mechanisms of action for an evidence-based and theoretically informed intervention targeting adults with cancer and family caregivers. This research provides a solid foundation for future work to advance interventional oncology research.