Sarah Day

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

Objectives To explore healthcare workers’ (HCWs) 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 public 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 based on region, healthcare level and job role. A total of 56 participants (26 in SA and 30 in Zimbabwe) participated in the in-depth interviews. 26 (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, HCWs’ perceptions of patient-level factors influencing the diagnostic interval included financial limitations, 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 socioeconomic 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.

Navigating cancer: Insights from patient journey mapping

Background Cancer is an increasing public health problem in South Africa, with breast cancer being the most diagnosed cancer and cervical cancer the leading cause of cancer deaths among women. Despite the complexity of breast and cervical cancer patients’ journeys through the healthcare system, patients’ voices are still predominantly missing from the body of literature. Patient journey mapping, as a qualitative research method, offers an opportunity for centring patients in their care journeys and reimagine healthcare provision for the potential improvement of health systems and patient outcomes. Aim The aim of this study was to map journeys of breast and cervical cancer patients across the cancer care continuum. Methods Using patient journey mapping, we conducted six focus group discussions with patients with breast and cervical cancer who had completed treatment in Gauteng, KwaZulu Natal and the Western Cape, South Africa. The process involved three steps: 1.) development of individual maps; 2.) narrative sharing; and 3.) development of a collective map. Results of the study were shared in feedback sessions. Findings A total of 31 people participated in the focus groups: 23 with breast cancer, 7 cervical cancer and one had both cancers during her lifetime. The participants’ ages ranged between 30 and 69 years old. A patient journey map was developed drawing on the individual and collective maps and participant narratives. The findings of the paper constellate around three themes. The first theme, (de)personalised care, offers an examination of how relational, institutional and structural factors shape and are reshaped through participants lived experiences across the cancer care continuum. The second theme, self-advocacy, explores how participants advocate for their healthcare needs throughout the cancer care continuum. The third theme, intersecting vulnerabilities, explores how intersecting social identities, such as socioeconomic factors, gender, comorbidities and mental health, shape their cancer care journeys. Conclusions By centring patient with breast and cervical cancer voices, patient journey mapping not only showed where services and systems fall short but also provided guidance for redesigning a more patient responsive health system.