Barriers to Optimal Palliative Care Pharmacy Practice at Oncology and Chronic Disease Units in North West Nigeria: An Empirical Investigation

Palliative care pharmacy encompasses the provision of pharmaceutical services to patients with life-limiting illnesses, including pain management, symptom control, medication reconciliation, and family caregiver education. Despite the growing burden of cancer and chronic disease in North West Nigeria, palliative care pharmacy is an underdeveloped subspecialty. This study empirically investigated barriers to optimal palliative care pharmacy practice at oncology and chronic disease units in Kano, Sokoto, and Kebbi States. A qualitative-dominant mixed-methods approach was employed, combining in-depth interviews with 30 pharmacists, oncologists, and palliative care nurses, structured surveys with 80 pharmacists, and document review of palliative care service records. Barriers were organized into five thematic categories: knowledge and training deficits, opioid access and regulatory restrictions, workforce and infrastructure limitations, systemic healthcare financing gaps, and sociocultural attitudes toward palliative care. Opioid availability was identified as the most critical pharmacist-perceived barrier, reported by 84 percent of respondents. Only 19 percent of pharmacists had received any formal palliative care training. Palliative care pharmacy protocols were absent in all three states. The study recommends a regional palliative care pharmacy development program for North West Nigeria, including opioid access reform, pharmacist training in symptom management pharmacotherapy, and formal inclusion of pharmacists in palliative care multidisciplinary teams. Keywords: palliative care pharmacy, oncology, opioid access, North West Nigeria, symptom management