Currently there are no documented studies about the end-of-life preferences of Mozambicans. Locally, the field of palliative care is still being established and is very much in its initial stages. Palliative care should be tailored to the culture and customs of the population it aims to serve. This thesis is a cohesive body of work which establishes a foundation of knowledge about the end-of-life preferences and priorities of Mozambicans. It begins with a narrative review, which explored the patient/physician communication relationship in sub-Saharan Africa, with a focus on Mozambique. The results from the review led to a second manuscript, which examined measurement tools for end-of-life preferences. Gaps were identified in knowing how to appropriately understand patient preferences due to uncovered barriers in the patient/physician relationship, as well as, not having a culturally informed survey to use in the community. In response, the original research was to design a novel survey rooted in Mozambican culture and then to overcome barriers, implement it in the communities, outside of the medical system.

The cross-sectional survey took place in Maputo City Province, the capital of Mozambique in March 2025. Eligible participants were Mozambican nationals, fluent in Portuguese, who were >18 years old. Convenience sampling was used, then participants (N=399) participated in an oral survey, consisting of 42 questions about illness understanding, patient practices, preferences in decision making, patient/physician communication, comfort talking about death, personal experience with death, preferred location of death, importance ratings of topics at the end-of-life, preferences if treatment stops working and imagining a “good death”, and about afterlife and ancestralism. Participants were male (57.6%) and female (42.4%) with a majority being between the ages of 18-30 (59.6%).

This research resulted in a broad understanding of general preferences and priorities of Mozambicans from Maputo City Province, including family as an integral part of decision-making, a desire for doctors to honest, and a general comfort talking about death. Binary logistic regression analyses provided information about preferences for truth-telling and found that education, religion, and ethnicity influence these preferences. This data gives practical implications of physicians need for training in end-of-life communication.