title: Telemedicine's Potential to Support Good Dying in Nigeria: A Qualitative Study.
abstract: OBJECTIVE
  This qualitative study explores Nigerian health care professionals' concepts of good dying/a good death and how telemedicine technologies and services would fit the current Nigerian palliative care practice.
  
  
  METHODS
  Supported by the Centre for Palliative Care Nigeria (CPCN) and the University College Hospital (UCH) in Ibadan, Nigeria, the authors organized three focus groups with Nigerian health care professionals interested in palliative care, unstructured interviews with key role players for palliative care and representatives of telecom companies, and field visits to primary, secondary and tertiary healthcare clinics that provided palliative care. Data analysis consisted of open coding, constant comparison, diagramming of categorizations and relations, and extensive member checks.
  
  
  RESULTS
  The focus group participants classified good dying into 2 domains: a feeling of completion of the individual life and dying within the community. Reported barriers to palliative care provision were socio-economic consequences of being seriously ill, taboos on dying and being ill, restricted access to adequate medical-technical care, equation of religion with medicine, and the faulty implementation of palliative care policy by government. The addition of telemedicine to Nigeria's palliative care practice appears problematic, due to irregular bandwidth, poor network coverage, and unstable power supply obstructing interactivity and access to information. However, a tele-education 'lite' scenario seemed viable in Nigeria, wherein low-tech educational networks are central that build on non-synchronous online communication.
  
  
  CONCLUSIONS
  Nigerian health care professionals' concepts on good dying/a good death and barriers and opportunities for palliative care provision were, for the greater part, similar to prior findings from other studies in Africa. Information for and education of patient, family, and community are essential to further improve palliative care in Africa. Telemedicine can only help if low-tech solutions are applied that work around network coverage problems by focusing on non-synchronous online communication.
authors.affiliation: Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: van Gurp
authors.affiliation: Centre for Palliative Care Nigeria and Hospice and Palliative Care Unit, University College Hospital, Ibadan, Nigeria.
authors.forename: Olaitan
authors.initials: O
authors.lastname: Soyannwo
authors.affiliation: Hospice and Palliative Care Unit, University College Hospital, Ibadan, Nigeria.
authors.forename: Kehinde
authors.initials: K
authors.lastname: Odebunmi
authors.affiliation: Department of Telemedicine, University College Hospital, Ibadan, Nigeria.
authors.forename: Simpa
authors.initials: S
authors.lastname: Dania
authors.affiliation: Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Martine
authors.initials: M
authors.lastname: van Selm
authors.affiliation: Department of IQ Healthcare, Ethics Section, Radboud University Medical Center, Nijmegen, Netherlands.
authors.forename: Evert
authors.initials: E
authors.lastname: van Leeuwen
authors.affiliation: Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
authors.affiliation: Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hasselaar
mesh_terms: D017144:Focus Groups; D006801:Humans; D009549:Nigeria; D010166:Palliative Care; D036301:Qualitative Research; D017216:Telemedicine