Provision of prostate cancer services in Tanzania: perspectives from five tertiary hospitals.
Prostate cancer
Quality of service
Structural inputs
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
30 Sep 2024
30 Sep 2024
Historique:
received:
27
01
2024
accepted:
11
09
2024
medline:
1
10
2024
pubmed:
1
10
2024
entrez:
1
10
2024
Statut:
epublish
Résumé
Access to quality prostate cancer services remains a global challenge, particularly in Low- and Middle-Income countries. This is often due to weak health systems that struggle to meet the population's needs. The provision of quality health services to patients with prostate cancer requires a comprehensive approach involving multiple stakeholders and structural inputs. However, few studies have comprehensively assessed the relationship between these structural inputs and prostate cancer treatment outcomes. This study, therefore, aimed to determine the availability of selected structural inputs and descriptions of how they influence the provision of quality services to patients with prostate cancer in Tanzania. We conducted a cross-sectional study using an explanatory sequential mixed-method approach to collect data from five tertiary hospitals providing cancer services in Tanzania. A validated checklist was used to collect information on available structural inputs for prostate services at tertiary hospitals. A semi-structured interview guide was used to conduct 42 in-depth interviews with 20 healthcare providers, five hospital managers, and 17 patients undergoing treatment for prostate cancer. Descriptive analysis was performed for the quantitative data, and thematic analysis was conducted with the aid of NVivo 14 qualitative software for the interview transcripts. All five assessed tertiary hospitals had inadequate human resources for health to provide prostate cancer services. Only one had 70% of the required HRH, while none had above 40% of the required HRH. Within the hospitals, the skill mix imbalance was severe across cadres. Five themes emerged: inadequate infrastructure, delays in diagnosis, delays in treatment, shortage of human resources for health (HRH), and inefficient organization of prostate cancer services. The findings of this study, underscore the major health system deficiencies for the provision of prostate cancer services in tertiary hospitals. With the increased aging population, strong health systems are vital in addressing conditions of old aging, including prostate cancers. Studies on optimization of the available HRH and infrastructure are needed to improve the provision of prostate cancer in tertiary hospitals as an interim solution while long-term measures are needed for improving the HRH availability and conducive infrastructure.
Sections du résumé
BACKGROUND
BACKGROUND
Access to quality prostate cancer services remains a global challenge, particularly in Low- and Middle-Income countries. This is often due to weak health systems that struggle to meet the population's needs. The provision of quality health services to patients with prostate cancer requires a comprehensive approach involving multiple stakeholders and structural inputs. However, few studies have comprehensively assessed the relationship between these structural inputs and prostate cancer treatment outcomes. This study, therefore, aimed to determine the availability of selected structural inputs and descriptions of how they influence the provision of quality services to patients with prostate cancer in Tanzania.
METHODS
METHODS
We conducted a cross-sectional study using an explanatory sequential mixed-method approach to collect data from five tertiary hospitals providing cancer services in Tanzania. A validated checklist was used to collect information on available structural inputs for prostate services at tertiary hospitals. A semi-structured interview guide was used to conduct 42 in-depth interviews with 20 healthcare providers, five hospital managers, and 17 patients undergoing treatment for prostate cancer. Descriptive analysis was performed for the quantitative data, and thematic analysis was conducted with the aid of NVivo 14 qualitative software for the interview transcripts.
RESULTS
RESULTS
All five assessed tertiary hospitals had inadequate human resources for health to provide prostate cancer services. Only one had 70% of the required HRH, while none had above 40% of the required HRH. Within the hospitals, the skill mix imbalance was severe across cadres. Five themes emerged: inadequate infrastructure, delays in diagnosis, delays in treatment, shortage of human resources for health (HRH), and inefficient organization of prostate cancer services.
CONCLUSION
CONCLUSIONS
The findings of this study, underscore the major health system deficiencies for the provision of prostate cancer services in tertiary hospitals. With the increased aging population, strong health systems are vital in addressing conditions of old aging, including prostate cancers. Studies on optimization of the available HRH and infrastructure are needed to improve the provision of prostate cancer in tertiary hospitals as an interim solution while long-term measures are needed for improving the HRH availability and conducive infrastructure.
Identifiants
pubmed: 39350208
doi: 10.1186/s12913-024-11580-1
pii: 10.1186/s12913-024-11580-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1154Informations de copyright
© 2024. The Author(s).
Références
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.
doi: 10.3322/caac.21660
pubmed: 33538338
Wang L, Lu B, He M, Wang Y, Wang Z, Du L. Prostate Cancer incidence and mortality: global status and temporal trends in 89 countries from 2000 to 2019. Front Public Heal. 2022;10(February).
Ngwa W, Addai BW, Adewole I, Ainsworth V, Alaro J, Alatise OI, et al. Cancer in sub-saharan Africa: a Lancet Oncology Commission. Lancet Oncol. 2022;23(6):e251–312.
doi: 10.1016/S1470-2045(21)00720-8
pubmed: 35550267
pmcid: 9393090
Rubagumya F, Costas-Chavarri A, Manirakiza A, Murenzi G, Uwinkindi F, Ntizimira C et al. State of Cancer Control in Rwanda: past, Present, and Future opportunities. JCO Glob Oncol. 2020;(6):1171–7.
Makene FS, Ngilangwa R, Santos C, Cross C, Ngoma T, Mujinja PGM et al. Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis. BMC Health Serv Res. 2022;22(1):1–14. https://doi.org/10.1186/s12913-021-07438-5
Lyimo EP, Rumisha SF, Mremi IR, Mangu CD, Kishamawe C, Chiduo MG, et al. Cancer mortality patterns in Tanzania: a retrospective hospital-based study, 2006–2015. J Glob Oncol. 2020;6:224–32.
doi: 10.1200/JGO.19.00270
Ngowi BN, Mremi A, Mbwambo OJ, Mitao MP, Nyindo M, Mteta KA et al. Prostate cancer knowledge and barriers to screening among men at risk in northern Tanzania: A community-based study. Cancer Treat Res Commun. 2024;39(April):100811. https://doi.org/10.1016/j.ctarc.2024.100811
Litwin MS, Steinberg M, Malin J, Naitoh J, McGuigan KA, Steinfeld R et al. Prostate Cancer patient outcomes and choice of providers: Development of an Infrastructure for Quality Assessment. Santa Monica, CA: RAND Corporation; 2000.
Ayanian JZ, Markel H. Donabedian’s lasting Framework for Health Care Quality. N Engl J Med. 2016;375(3):205–7.
doi: 10.1056/NEJMp1605101
pubmed: 27468057
Modi PK, Yan P, Hollenbeck BK, Kaufman SR, Borza T, Skolarus TA, et al. Urologist Pract Struct Qual Prostate cancer care. 2021;7(5):419–24.
Tsu JHL. Importance of patient-reported outcomes and health-related quality of life when considering prostate cancer treatment. Hong Kong Med J. 2020;26(2):88–9.
doi: 10.12809/hkmj205095
pubmed: 32300071
Herrel LA, Kaufman SR, Yan P, Miller DC, Schroeck FR, Skolarus TA, et al. Health Care Integration and Quality among men with prostate Cancer. J Urol. 2017;197(1):55–60.
doi: 10.1016/j.juro.2016.07.040
pubmed: 27423758
Creswell JW, Creswell JD. Mixed Methods Procedures. Research Defign: Qualitative, Quantitative, and Mixed M ethods Approaches. 2018. pg 418.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
doi: 10.1191/1478088706qp063oa
Ahmed SK. The pillars of trustworthiness in qualitative research. J Med Surg Public Heal. 2024;2(January):100051.
doi: 10.1016/j.glmedi.2024.100051
Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004;22(2):63–75.
Haakenstad A, Irvine CMS, Knight M, Bintz C, Aravkin AY, Zheng P, et al. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the global burden of Disease Study 2019. Lancet. 2022;399(10341):2129–54.
doi: 10.1016/S0140-6736(22)00532-3
Merriel SWD, Archer S, Forster AS, Eldred-Evans D, McGrath J, Ahmed HU, et al. Experiences of traditional and one-stop MRI-based prostate cancer diagnostic pathways in England: a qualitative study with patients and GPs. BMJ Open. 2022;12(7):1–9.
doi: 10.1136/bmjopen-2021-054045
Sanghera S, Mohiuddin S, Coast J, Garfield K, Noble S, Metcalfe C, et al. Modelling the lifetime cost-effectiveness of radical prostatectomy, radiotherapy and active monitoring for men with clinically localised prostate cancer from median 10-year outcomes in the ProtecT randomised trial. BMC Cancer. 2020;20(1):1–10.
doi: 10.1186/s12885-020-07276-4
Tremblay D, Roberge D, Cazale L, Touati N, Maunsell E, Latreille J et al. Evaluation of the impact of interdisciplinarity in cancer care. BMC Health Serv Res. 2011;11(1):144. http://www.biomedcentral.com/1472-6963/11/144
Bulte JP, Halilovic A, Burgers LJM, Diepenbroek CJM, De La Roij RAK, Mann RM, et al. Accelerated tissue processing with minimal formalin fixation time for 9-gauge vacuum-assisted breast biopsy specimens: a proof of Principle. Am J Clin Pathol. 2020;153(1):58–65.
doi: 10.1093/ajcp/aqz111
pubmed: 31415692
Bai L, Wushouer H, Huang C, Luo Z, Guan X, Shi L. Health Care utilization and costs of patients with prostate Cancer in China based on National Health Insurance Database from 2015 to 2017. Front Pharmacol. 2020;11(June).
Kowalchuk RO, Kim H, Harmsen WS, Jeans EB, Morris LK, Mullikin TC, et al. Cost effectiveness of treatment strategies for high risk prostate cancer. Cancer. 2022;128(21):3815–23.
doi: 10.1002/cncr.34450
pubmed: 36070558
Nyongole OV, Kivuyo NE, Akoko LO, Saronga H. Estimating cost of prostate cancer management: an experience from Tanzania. African J Urol. 2024; https://doi.org/10.1186/s12301-024-00422-5
Seymour ZA, Daignault-Newton S, McLaughlin PW, Sandler H, Jackson W, Johnson SB et al. Patient reported outcomes for quality of life (QOL) by Expanded Prostate Cancer Index (EPIC) on average 15 years post treatment. Clin Transl Radiat Oncol. 2022;36(June):56–62. https://doi.org/10.1016/j.ctro.2022.05.007
Freddie B, Ariana Z, Cueva P, Korir A, Swaminathan R, Ullrich A et al. Planning and Developing Population-Based Cancer Registration in Low- or Middle-Income Settings. Planning and Developing Population-Based Cancer Registration in Low- or Middle-Income Settings. 2021. 1–46 p. http://europepmc.org/books/NBK566957%0A https://europepmc.org/article/med/33502836
The United Republic of Tanzania Ministry of Health and Social Welfare. National Cancer Control Strategy (NCCS) 2013–2022. 2013. 2013;72. http://iccp-portal.org
Gakunga R, Parkin DM. Cancer registries in Africa 2014: a survey of operational features and uses in cancer control planning. Int J Cancer. 2015;137(9):2045–52.
doi: 10.1002/ijc.29668
pubmed: 26135162
Makungu ML, Mweya CN. Assessing knowledge, attitude and practice towards prostate cancer screening among males in Southwest Tanzania: A cross-sectional study. Cancer Treat Res Commun. 2023;36(May):100716. https://doi.org/10.1016/j.ctarc.2023.100716
Mbugua RG, Karanja S, Oluchina S. Barriers and facilitators to uptake of prostate Cancer screening in a Kenyan Rural Community. 2021;18(3):130–6.
Ocran Mattila P, Ahmad R, Hasan SS, Babar ZUD, Availability. Affordability, Access, and pricing of anti-cancer Medicines in Low- and Middle-Income countries: a systematic review of literature. Front Public Heal. 2021;9(April).
World Health Organization. WHO report on cancer: setting priorities, investing wisely and providing care for all. Geneva: World Health Organization; 2020.