Caregiver Death Preparedness in Ghana: Awareness, Emotional and Behavioral Dimensions of End-of-Life Care

Abstract

Background: Caregiver preparedness for the death of a loved one is increasingly recognized as a critical component of palliative care. In Ghana, cultural taboos, religious beliefs, and limited support systems influence how families approach this process, yet little is known about how caregivers themselves navigate death preparedness. Objective: This study explored the dimensions of caregiver death preparedness in Ghana, focusing on awareness, emotional responses, and behavioral actions. Methods: A qualitative descriptive design was employed at the Palliative Care Unit of Tetteh Quarshie Memorial Hospital, the only in-patient palliative care facility in Ghana. Twelve informal family caregivers of terminally ill patients were purposively recruited, and data saturation was achieved. Semi-structured interviews were conducted, transcribed verbatim, and analyzed thematically. Trustworthiness was enhanced through member checking, reflexivity, and use of verbatim quotes. Findings: Three interrelated dimensions of preparedness were identified. Awareness included knowledge of disease, recognition of disease stage, and anticipation (or denial) of death. Emotional responses ranged from denial, fear, and turmoil to faith-based rationalization and eventual acceptance, often shaped by spirituality. Behavioral actions reflected caregivers’ responses to awareness and emotions, including persistent efforts toward recovery, financial and legal planning, and fulfilment of last wishes. Preparedness varied widely, with unpreparedness often linked to denial and reliance on hope. Conclusion: Caregiver death preparedness in Ghana is a dynamic, multidimensional process shaped by the interplay of awareness, emotion, and behavior. These findings provide evidence to guide culturally sensitive caregiver interventions and inform the integration of caregiver support into palliative care services and policy in Ghana and similar settings.