Influence of supportive care on chemotherapy patients' self-care behaviour and satisfaction: A pilot study conducted in Karachi, Pakistan

Supportive care interventions for cancer patients in low- and middle-income countries (LMICs): a scoping review

PURPOSE

In high-income countries (HICs), supportive care is often used to assist cancer patients as they seek treatment and beyond. However, in low-and middle-income countries (LMICs), where more than 70% of all cancer-related deaths occur [1], the provision of supportive care has not been assessed. The purpose of this scoping review is to assess the type of supportive care interventions for cancer patients across the cancer care continuum in LMICs.

METHODS

We examined published articles reporting on supportive care interventions in LMICs. Following PRISMA guidelines, we performed a systematic search of PubMed, ERIC, CINAHL, and PsycINFO. We limited the scope to original research studies focused on LMICs, studies concerning any type of supportive care intervention for adult cancer patients, from diagnosis, treatment, and post-treatment.

RESULTS

Thirty-five studies met the criteria for inclusion in the scoping review. The majority were randomized clinical trials (RCT) or used a quasi-experimental design. The highest number of studies (n = 23) was implemented in the WHO Eastern-Mediterranean region, followed by South-East Asia (n = 6), Africa (n = 4), and Western-Pacific Regions (n = 2). Most studies focused on women's cancers and included interventions for psychosocial support, symptom management, health literacy/education, and patient navigation.

CONCLUSIONS

Although we found only a small number of interventions being conducted in these settings, our results suggest that providing different types of supportive services in less-resourced settings, even when health systems are fragmented and fragile, can improve mental health, physical health, and the quality of life (QoL) of cancer patients.

A systematic rapid review on quality of care among non-communicable diseases (NCDs) service delivery in South Asia

Background

At present, poor quality of care (QoC) surrounding non-communicable diseases (NCDs) service provision poses a threat to South Asia. This systematic rapid review aims to highlight the available approaches to improve QoC in NCD services in South Asian countries.

Methods

Three electronic databases (Medline, Embase, and the Cochrane Library) were used to identify relevant literature. Studies published from January 1, 1990 to December 31, 2020 were included. Studies published in English in the South Asian context following any research design about four major NCDs (cancer, diabetes, cardiovascular disease, chronic respiratory disease), and interventions to achieve QoC were included. Data extraction was done using a pre-specified form. A narrative synthesis was conducted for analyzing the extracted information. This systematic rapid review is registered in PROSPERO (International prospective register of systematic reviews) - CRD42020157401.

Results

Among 829 identified studies, 13 were included in the review for in-depth analysis. Most of the studies focused on cancer followed by diabetes and cardiovascular disease. Community and clinic-based screening, NCD care education, NCD specialized corner or hospital, and a follow-up system ensure patient satisfaction, accessibility, early detection, timely referral, and help to reduce disease severity, mortality rate, and incidence of the new disease.

Conclusions

Effective interventions for improving QoC surrounding NCD services can be scaled up in different settings in South Asia to reduce the burden of NCDs.

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There are knowledge gaps in quality of care among Non-Communicable Diseases (NCDs) service delivery.

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Community and clinic-based screening, NCD care education, and NCD specialized hospitals may improve the quality of care.

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More research on quality of care is required as there are limited number of experimental studies.

The quality of patient care in oncology departments in Karachi, Pakistan: patients' perceptions

PURPOSE

This study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed.

DESIGN/METHODOLOGY/APPROACH

This is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values.

FINDINGS

The authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value < 0.01 using t-test for two independent samples). The data showed an increasing trend of "satisfied" responses as the household income increased.

RESEARCH LIMITATIONS/IMPLICATIONS

A comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor's approach to their patients, time given during each consultation and patient's understanding of doctor's knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care.

PRACTICAL IMPLICATIONS

Assessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients' concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient's needs and doctor availability.

SOCIAL IMPLICATIONS

After being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient's self efficacy in managing important aspects of their care and improves health care-related quality of life.

ORIGINALITY/VALUE

Cancer patients have long-term exposure to the hospital environment. A patient's satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes.