Background:
Community-based palliative care programmes (CBPCP) improve patient outcomes and caregiver experiences in a cost-effective manner in high-income countries. However, despite CBPCP being a vital component of cancer control, structural and social care gaps in low-and-middle-income countries (LMICs) have limited the generation of evidence to guide the design and implementation of these programmes. This gap is particularly evident in Nigeria.

Objective:
This study explored caregivers’ perceptions of the anticipated acceptability, feasibility, and sustainability of CBPCP in three Nigerian states.

Methods:
We conducted a qualitative study in 6 purposively selected communities across FCT, Nasarawa, and Rivers states, Nigeria, between September and November 2024. The study was implemented in collaboration with local health authorities and community leaders. Data were collected through six focus group discussions using a semi-structured interview guide among 45 purposively sampled adult female and male caregivers of women diagnosed with, or who had died from, breast or cervical cancer. Discussions explored caregivers’ care needs and caregiving challenges, the availability of community-based palliative care initiatives, and perceptions of the anticipated acceptability, feasibility, perceived usefulness and long-term sustainability of CBPCP. Data was analyzed using an iterative, inductive-deductive thematic approach. Emerging themes were interpreted using the PRECEDE-PROCEED model which guided the identification of predisposing, enabling and reinforcing factors.

Results:
Across the 3 states, caregivers’ perspectives highlighted multiple predisposing, enabling and reinforcing factors relevant to the design and potential sustainability of CBPCP. Participants comprised of 15 male and 30 female caregivers.

Predisposing Factors (Beliefs and Attitudes): Trust and confidence in both health and community systems emerged as a key determinant influencing of the anticipated acceptability, feasibility and sustainability of CBPCP. Participants viewed CBPCP as acceptable and responsive to needs of the community, provided activities are ethical, clearly communicated, and tailored to women living with BC and CC.

Enabling Factors (Resources and Structures): Participants reported an absence of organized CBPCP, with existing-support largely limited to a few faith-based organizations.  Despite this gap, CBPCP was considered feasible if implemented through strong engagement with key community actors, including traditional leaders, women leaders, religious leaders, cancer survivors, and spouses of affected women. Respondents added that leveraging existing service delivery models, such as the HIV programmes could facilitate community-mobilization, advocacy, and sustained engagement.
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Reinforcing Factors (Community and System-Support): Participants identified political support and institutional support measures to prevent financial mismanagement and strong linkages with existing healthcare facilities to ensure continuity of care and integration with formal health systems. Engagement of key community actors and ongoing assessment of programme value were viewed as critical for long-term sustainability.

Conclusion:
Caregivers indicated CBPCP as an urgent and acceptable need within their communities, with feasibility strongly anchored in grassroots participation and stakeholder engagement. They emphasized the active engagement and education of community members, leaders and survivors for successful implementation, while sustainability was perceived to be dependent on political commitment, financial accountability and integration with the existing health care facilities. These findings underscore the importance of locally driven partnerships and capacity strengthening approaches in designing and implementing CBPCP in LMIC settings.