Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania

The oncologist

article

Sarah Kutika Nyagabona¹  Edith Tarimo¹  Geoffrey Buckle²  Msiba Selekwa¹  Beatrice Mushi¹  Elia John Mmbaga¹  Katherine Van Loon²  Rebecca J. DeBoer²  Rohan Luhar²  Jerry Ndumbalo⁴  Nanzoke Mvungi⁴  Mamsau Ngoma⁴  Stephen Meena⁴  Sadiq Siu⁴  Mwamvita Said⁴  Julius Mwaiselage⁴ 

[1] Muhimbili University of Health and Allied Sciences;Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center;University of Oslo;Ocean Road Cancer Institute

关键词: Cancer care facilities;    Guideline adherence;    Implementation science;    Quality improvement;    Low;    and middle-income countries;    Africa;   

DOI  :  10.1002/onco.13834

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background In response to the increasing burden of cancer in Tanzania, the Ministry of Health, Community Development, Gender, Elderly and Children launched National Cancer Treatment Guidelines (TNCTG) in February 2020. The guidelines aimed to improve and standardize oncology care in the country. At Ocean Road Cancer Institute (ORCI), we developed a theory-informed implementation strategy to promote guideline-concordant care. As part of the situation analysis for implementation strategy development, we conducted focus group discussions to evaluate clinical systems and contextual factors that influence guideline-based practice prior to the launch of the TNCTG. Materials and Methods In June 2019, three focus group discussions were conducted with a total of 21 oncology clinicians at ORCI, stratified by profession. A discussion guide was used to stimulate dialogue about facilitators and barriers to delivery of guideline-concordant care. Discussions were audio recorded, transcribed, translated, and analyzed using thematic framework analysis. Results Participants identified factors both within the inner context of ORCI clinical systems and outside of ORCI. Themes within the clinical systems included capacity and infrastructure, information technology, communication, efficiency, and quality of services provided. Contextual factors external to ORCI included interinstitutional coordination, oncology capacity in peripheral hospitals, public awareness and beliefs, and financial barriers. Participants provided pragmatic suggestions for strengthening cancer care delivery in Tanzania. Conclusion Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect uptake of the TNCTG. Our findings were used to inform a broader guideline implementation strategy, in an effort to improve uptake of the TNCTGs at ORCI. Implications for Practice This study provides an assessment of cancer care delivery systems in a low resource setting from the unique perspectives of local multidisciplinary oncology clinicians. Situational analysis of contextual factors that are likely to influence guideline implementation outcomes is the first step of developing an implementation strategy for cancer treatment guidelines. Many of the barriers identified in this study represent actionable targets that will inform the next phases of our implementation strategy for guideline-concordant cancer care in Tanzania and comparable settings.

【 授权许可】

CC BY|CC BY-NC