Challenges and facilitators in pathways to cancer diagnosis in Southern Africa: A qualitative study

Objectives

To explore healthcare workers (HCW) experiences, barriers and facilitators in managing patients with symptoms of possible breast, cervical or colorectal cancer.

Design

A qualitative in-depth interview study with HCWs managing patients with breast, cervical and colorectal cancer symptoms. We also conducted workshops with a group of HCWs to check the credibility of the interview findings.

Setting

The study was conducted with staff working in primary, secondary and tertiary health facilities in the Eastern and Western Cape in South Africa (SA) and Harare and Bulawayo and their referral provinces in Zimbabwe.

Participants

HCWs with experience in managing patients with symptoms of possible breast, cervical or colorectal cancer were recruited for the study. Participants were purposively sampled, according to region, healthcare level, and job role. A total of 56 participants (26 in SA and 30 in Zimbabwe) participated in the in-depth interviews. Twenty-six (12 in SA and 14 in Zimbabwe) participated in four clinical advisory group workshops across both countries.

Results

Drawing on the Model of Pathways to Treatment, HCW perceptions of patient-level factors influencing the diagnostic interval included financial limitations, and patients’ absence and delays in attendance. Healthcare provider and system factors included: challenges with referral and feedback systems; training needs; low awareness of protocols and guidelines; inappropriate and suboptimal clinical assessments; and broader socio-economic factors and resource limitations.

Conclusion

Improving the timely diagnosis of breast, cervical, and colorectal cancer in Southern Africa necessitates targeted strategies that address both patient-related, provider and health-system delays.

Strengths and Limitations

• To our knowledge, this is the first study in SA and Zimbabwe that explores healthcare workers across all levels of care perceptions of the challenges and facilitators in the pathways to breast, cervical and colorectal cancer diagnosis.

• The qualitative nature of the inquiry and strong theoretical underpinning with the Model of Pathways to Treatment enabled in-depth exploration of the research question.

• The study setting included both urban and rural settings that represent differences in access to cancer care and health systems.

• We note that the discussion of patient level facilitators and barriers to early diagnosis are the perceptions of HCWs and not the views of the patients themselves.

• By examining cancer care in two distinct countries, the study provides valuable insights into how different levels of human development index impact healthcare systems and identify unique challenges and best practices. A comparative analysis reveals important differences in health outcomes and resource allocation, which can inform targeted interventions.