Exploring the Perception of Death and Health Related Quality of Life in the Ghanaian Context

Abstract

Background: In many healthcare systems around the world, quality-adjusted life years (QALYs) is a pivotal and influential metric in the complex process of resource allocation decision-making. Conversely, traditional measures like life expectancy and causes of death, while important for population health analysis, lack the ability to gauge the quality of life in physical, mental, and social dimensions. Physical symptoms, poor functional performance, psychological problems, social concerns, and existential issues typically contribute to a person's suffering in advanced. At the terminal stage of suffering from these diseases, where treatment and palliative care are not viable, people normally believe it is better to die than to live, which has led to the concept "worse than death" (WTD) health state. There is little evidence that has qualitatively elucidated people’s perception of death, what is being considered as worse than death health state and factors that influence people’s perception of considering some conditions to be WTD in Ghana. Aim: This study explored the perception of worse than death and health-related quality of life among Ghanaian adults in the three ecological zones. Methods: This study employed a phenomenological design approach to explore the understanding of health-related quality of life and worse than death health states. A convenience sampling method was used to sample Twenty-Eight (28) participants. Participants of the study were healthy adult menand women who participated in an EQ-VT protocol valuation survey (a quantitative study) and considered some health states as worse than death. These included 17 males and 11 females. Then, in-depth interviews were used to collect data from the participants. At least 10 participants were interviewed from the three ecological zones (Coastal Zone, Middle Belt, Northern Zone) to better understand Ghanaians' perception of health and well-being and death considering the contextual, religious, and cultural influences on their 'worse than death' health status. Interviews were audio recorded with consent from participants, transcribed, and analyzed using an inductive thematic analytical technique. Results: Findings from the study revealed that participants were knowledgeable about health-related quality of life, how they felt it affected health on the various domains (mobility, self-care, regular activities, pain/discomfort, and anxiety/depression) of life. Health states people considered worse than death included physical pain, social, mobility, and emotional functions and their corresponding severity levels. Findings from the study revealed that reasons for stating those conditions as worse than death were from what they have observed and experienced. Most of the experiences were either personal, from family members and community members. In addition, pains, suffering, being a nuisance, mistreatment, useless, helpless, lifeless and not happy were some of the factors that participants would not want to be in a state worse than death. Conclusion: The study concludes that the participants understand that their health states can affect their quality of life. The worse than death states where participants feel uncomfortable, perceive wasting of the productive time of those who take care of them, dependent, bedridden and disgraced are factors contributing to the decisions in worse than death states. The study recommends that worse than death health states should be taken into consideration by policy-makers and relevant stakeholders in the health sector to enhance the quality of life of people who are suffering some terminal illness.