Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health

A qualitative study on the psycho-oncological experiences of women navigating breast cancer diagnosis, treatment, and survivorship in Ethiopia

PURPOSE

To understand the lived experiences of Ethiopian women who self-identify as breast cancer survivors, particularly facilitators, and barriers to engaging with care in biomedical settings.

METHODS

Between November 2022 and January 2023, six focus group discussions were conducted in Amharic with 44 breast cancer patients and survivors in Adama, Ethiopia, stratified based on HIV status and participation in available peer support groups at their treatment hospital. Thematic analysis was conducted, with methodology reported in accordance with the Consolidated Criteria for Reporting Qualitative research checklist.

RESULTS

Our analysis identified four key areas along the continuum of care: (1) recognition of BC-related symptoms, (2) seeking clinical care for BC symptoms, (3) adherence to BC treatment plans, and (4) coping strategies during ongoing care. Known facilitators for engagement in BC care included health education programming as well as emotional and financial support from loved ones and fellow survivors. However, participants described several barriers to clinical care such as the perception that BC is a death sentence, conflict between spiritual/traditional and clinical approaches to care, and fragmentation of care across multiple health facilities and providers.

CONCLUSIONS

Based on some of the identified barriers to care, future efforts to enhance cancer care in Ethiopian settings should consider national awareness campaigns for BC to dispel local myths and misconception about BC, formal partnerships between faith-based community leaders and health care providers, and the use of family- and community-centered models of cancer care in biomedical settings.

IMPLICATIONS FOR CANCER SURVIVORS

Recognition of psycho-oncological challenges to accessing clinical care for BC and providing opportunities for peer support and positive spirituality to navigate these challenges may improve patients' experiences in the Ethiopian biomedical system and reduce the potential negative experiences of future patients.

Kusankha Pamodzi: Health Care Decision-Making Preferences Among Patients with Cancer in Malawi

Background

Oncology teams are encouraged to include patient preferences and goals of care in determining appropriate treatment courses. There are no existing data from Malawi exploring decision-making preferences among cancer patients.

Methods

In the oncology clinic in Lilongwe, Malawi, 50 patients were surveyed for decision making.

Results

Most participants (70%, n = 35) preferred to engage in shared decision making regarding cancer treatment. About half (52%, n = 24) did not feel that their medical team involved them in decision making and 64% (n = 32) felt that they were never or only sometimes listened to by the medical team. Nearly all (94%, n = 47) preferred to have their medical team inform them how likely treatments are to lead to cure.

Conclusions

Shared decision making was the preferred mode of treatment decision making by the majority of the surveyed cancer patients in Malawi. Cancer patients in Malawi may have similar preferences to cancer patients in other low-resource settings regarding decision making and communication.

Communicating bad news to patients and families in African oncology settings

AIMS

To assess clinicians' self-reported knowledge of current policies in African oncology settings, of their personal communication practices around sharing bad news with patients, and to identify barriers to the sharing of serious news in these settings.

METHODS

A cross-sectional study of cancer care providers in African oncology settings (N = 125) was conducted. Factor analysis was used to assess cross-cultural adaptation and uptake of an evidence-based protocol for disclosing bad news to patients with cancer and of providers' perceived barriers to disclosing bad news to patients with cancer. Analysis of Various (ANOVA) was used to assess strength of association with each dimension of these two measurement models by various categorical variables.

RESULTS

Providers from Nigeria, Kenya, Ghana, and Rwanda represented 85% of survey respondents. Two independent, psychometrically reliable, multi-dimensional measurement models were derived to assess providers' personal communication practices and providers' perceived barriers to disclosing a cancer diagnosis. Forty percent (40%) of respondent nurses but only 20% of respondent physicians had had formal communications skills training. Approximately 20%-25% of respondent physicians and nurses reported having a consistent plan or strategy for communicating bad news to their cancer patients.

CONCLUSIONS

Results show that effective communication about cancer diagnosis and prognosis requires an appreciation and clinical skill set that blends an understanding of cancer-related internalized stigmas harbored by patient and family, dilemmas posed by treatment affordability, and the need to navigate family wishes about cancer-related diagnoses in the context of African oncology settings. Findings underscore the need for culturally grounded communications research and program design.