scholarly journals Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource Limited Context

2021 ◽  
Author(s):  
Rebecca J. DeBoer ◽  
Espérance Mutoniwase ◽  
Cam Nguyen ◽  
Anita Ho ◽  
Grace Umutesi ◽  
...  
Keyword(s):  
Priority Setting ◽  
Cancer Care ◽  
Moral Distress ◽  
Resource Limited

scholarly journals Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Kirtika Patel ◽  
R. Matthew Strother ◽  
Francis Ndiangui ◽  
David Chumba ◽  
William Jacobson ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cost Model ◽  
Tertiary Care ◽  
Care Hospital ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Limited Setting ◽  
Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

scholarly journals Selecting topic areas for developing quality standards in a resource-limited setting

2019 ◽  
Vol 8 (1) ◽  
pp. e000491
Author(s):  
Roongnapa Khampang ◽  
Sarayuth Khuntha ◽  
Phorntida Hadnorntun ◽  
Suthasinee Kumluang ◽  
Thunyarat Anothaisintawee ◽  
...  
Keyword(s):  
Priority Setting ◽  
Quality Standards ◽  
Healthcare Services ◽  
Priority Setting Process ◽  
Deliberative Process ◽  
Mortality And Morbidity ◽  
Stakeholder Consultation ◽  
Healthcare Settings ◽  
Resource Limited ◽  
Setting Process

Variation in practices of and access to health promotion and disease prevention (P&P) across geographical areas have been studied in Thailand as well as other healthcare settings. The implementation of quality standards (QS)—a concise set of evidence-informed quality statements designed to drive and measure priority quality improvements—can be an option to solve the problem. This paper aims to provide an overview of the priority setting process of topic areas for developing QS and describes the criteria used. Topic selection consisted of an iterative process involving several steps and relevant stakeholders. Review of existing documents on the principles and criteria used for prioritising health technology assessment topics were performed. Problems with healthcare services were reviewed, and stakeholder consultation meetings were conducted to discuss current problems and comment on the proposed prioritisation criteria. Topics were then prioritised based on both empirical evidence derived from literature review and stakeholders’ experiences through a deliberative process. Preterm birth, pre-eclampsia and postpartum haemorrhage were selected. The three health problems had significant disease burden; were prevalent among pregnant women in Thailand; led to high mortality and morbidity in mothers and children and caused variation in the practices and service uptake at health facilities. Having agreed-on criteria is one of the important elements of the priority setting process. The criteria should be discussed and refined with various stakeholders. Moreover, key stakeholders, especially the implementers of QS initiative, should be engaged in a constructive way and should be encouraged to actively participate and contribute significantly in the process.

scholarly journals International Radiotherapy Referrals From Rural Rwanda: Implementation Processes and Early Clinical Outcomes

2018 ◽  
pp. 1-12
Author(s):  
Maud Hanappe ◽  
Lowell T. Nicholson ◽  
Shekinah N.C. Elmore ◽  
Alexandra E. Fehr ◽  
Jean Bosco Bigirimana ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Head And Neck ◽  
Low Income ◽  
Cancer Care ◽  
Sub Saharan Africa ◽  
Resource Limited Settings ◽  
Cancer Centre ◽  
Resource Limited ◽  
Centre Of Excellence ◽  
Sub Saharan

Purpose Low- and middle-income countries disproportionately comprise 65% of cancer deaths. Cancer care delivery in resource-limited settings, especially low-income countries in sub-Saharan Africa, is exceedingly complex, requiring multiple modalities of diagnosis and treatment. Given the vast human, technical, and financial resources required, access to radiotherapy remains limited in sub-Saharan Africa. Through 2017, Rwanda has not had in-country radiotherapy services. The aim of this study was to describe the implementation and early outcomes of the radiotherapy referral program at the Butaro Cancer Centre of Excellence and to identify both successful pathways and barriers to care. Methods Butaro District Hospital is located in a rural area of the Northern Province and is home to the Butaro Cancer Centre of Excellence. We performed a retrospective study from routinely collected data of all patients with a diagnosis of cervical, head and neck, or rectal cancer between July 2012 and June 2015. Results Between 2012 and 2015, 580 patients were identified with these diagnoses and were potential candidates for radiation. Two hundred eight (36%) were referred for radiotherapy treatment in Uganda. Of those referred, 160 (77%) had cervical cancer, 31 (15%) had head and neck cancer, and 17 (8%) had rectal cancer. At the time of data collection, 101 radiotherapy patients (49%) were alive and had completed treatment with no evidence of recurrence, 11 (5%) were alive and continuing treatment, and 12 (6%) were alive and had completed treatment with evidence of recurrence. Conclusion This study demonstrates the feasibility of a rural cancer facility to successfully conduct out-of-country radiotherapy referrals with promising early outcomes. The results of this study also highlight the many challenges and lessons learned in providing comprehensive cancer care in resource-limited settings.

scholarly journals The Future of Global Radiation Oncology As Part of Accurate, Precision Cancer Medicine

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 91s-91s
Author(s):  
C.N. Coleman ◽  
M.K. Dosanjh ◽  
J. Buchsbaum ◽  
S. Formenti ◽  
D.A. Pistenmaa
Keyword(s):  
Global Health ◽  
Cancer Care ◽  
Radiation Injury ◽  
Space Exploration ◽  
Resource Limited ◽  
Personal Opinion ◽  
Nuclear Policy ◽  
The Future ◽  
Current Resource ◽  
Radiation Medicine

Background: When global health and cancer care are discussed, it is usually in the context of underserved communities, inadequate resources, standards of care below that in the developed world, loss of talented individuals to upper-income countries and the inability to recruit and retain a robust regional workforce. While such conditions may now exist, they are by no means “guaranteed” to be so in the future. Aim: To consider a visionary future for the radiation sciences to encourage investment by individuals in their careers and countries in their cancer care resources such that the current resource-limited facilities will be on the leading edge of accurate, precision radiation medicine. Such a change in perspective can greatly impact recruiting and retaining expertise. Methods: As part of building a visionary strategic plan for radiation oncology and the radiation sciences for the next few decades, a personal opinion paper was prepared by authors from the US National Cancer Institute, Conseil Européen pour la Recherche Nucléaire (CERN)/European Organization for Nuclear Research and the International Conference on Translational Research in Radio-Oncology/Physics for Health in Europe. Considering the critical role for global involvement in the future of radiation sciences, the paper provides a path forward via “win-win” sustainable partnerships formed by current resource-limited and resource-rich countries, as envisioned by the International Cancer Expert Corps ( www.iceccancer.org ). Results: The manuscript “ Accurate, precision radiation medicine: a meta-strategy for impacting cancer care, global health, nuclear policy, and mitigating radiation injury from necessary medical use, space exploration and potential terrorism” is in press. A figure (the Radiation Rotary) illustrates that there are a number of crossroads facing the radiation sciences best addressed as part of a rotary. Four sets of issues are illustrated: 1) cancer care with radiation therapy as both technology and biology, 2) global collaboration in technology development ranging from improved linear accelerators for resource-challenged environments to particle therapy for highly specialized uses, 3) nuclear policy, from energy to the potential for nuclear terrorism and conflagration, and 4) mitigating radiation injury including enabling long-term space exploration, helping reduce the fear of radiation and producing drugs to mitigate radiation injury. Conclusion: Many of these technology, research and development issues must involve LMICs. This is in addition to understanding the differences between upper- and lower-income regions in cancer biology and the environment, including infectious etiologies, diet and the microbiome. The talent and capability of radiation oncologists and related professionals within LMICs are essential to global health and economic development and provide incentives and unique opportunities for world-leading careers and contributions. Disclaimer: The content is the personal opinion of the authors and not their organizations

scholarly journals Using Technology to Improve Quality of Cancer Care in Resource-Limited Settings

2019 ◽  
Vol 5 (Supplement_1) ◽  
pp. 12-12 ◽  
Author(s):  
O.A. Silas ◽  
C.J. Achenbach ◽  
L. Hou ◽  
R.L. Murphy
Keyword(s):  
Cancer Research ◽  
Data Management ◽  
Cancer Care ◽  
Improve Quality ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Data Management Software

PURPOSE To highlight the importance of adapting affordable, holistic point-of-care technology (POCT) and data management software to improve quality of cancer care in resource-limited settings. Cancer is the second leading cause of death globally and was responsible for an estimated 9.6 million deaths in 2018, with low- and middle-income countries accounting for as much as 70% of these deaths. METHODS In 2004, the WHO outlined a set of criteria, called the ASSURED guidelines, to promote affordable, sensitive, specific, user-friendly, rapid, robust, equipment-free, and deliverable to end-user POCT. Although advances in POC cancer technology are relatively underexploited, early successes show that the field has significant potential to contribute to improving cancer detection, diagnosis, and treatment in low- and middle-income countries. RESULTS The current global disparity in cancer care can be addressed through mobilization of the research community to improve POCT, funding unique POCT concepts adapted for resource-limited settings, and training of scientists and engineers in designing robust data management software, such as the research electronic data capture for cancer research. CONCLUSION Improving cancer care holistically requires use of POCT with designs adapted to resource-limited settings and leveraging software with robust features for cancer research.

scholarly journals Establishing Cancer Treatment Programs in Resource-Limited Settings: Lessons Learned From Guatemala, Rwanda, and Vietnam

2018 ◽  
pp. 1-14
Author(s):  
Claire M. Wagner ◽  
Federico Antillón ◽  
François Uwinkindi ◽  
Tran Van Thuan ◽  
Sandra Luna-Fineman ◽  
...  
Keyword(s):  
Clinical Education ◽  
Cancer Care ◽  
Care Delivery ◽  
Case Reports ◽  
Lessons Learned ◽  
Treatment Programs ◽  
Program Leaders ◽  
Policy Goals ◽  
Resource Limited ◽  
Health Care Delivery Systems

Purpose The global burden of cancer is slated to reach 21.4 million new cases in 2030 alone, and the majority of those cases occur in under-resourced settings. Formidable changes to health care delivery systems must occur to meet this demand. Although significant policy advances have been made and documented at the international level, less is known about the efforts to create national systems to combat cancer in such settings. Methods With case reports and data from authors who are clinicians and policymakers in three financially constrained countries in different regions of the world—Guatemala, Rwanda, and Vietnam, we examined cancer care programs to identify principles that lead to robust care delivery platforms as well as challenges faced in each setting. Results The findings demonstrate that successful programs derive from equitably constructed and durable interventions focused on advancement of local clinical capacity and the prioritization of geographic and financial accessibility. In addition, a committed local response to the increasing cancer burden facilitates engagement of partners who become vital catalysts for launching treatment cascades. Also, clinical education in each setting was buttressed by international expertise, which aided both professional development and retention of staff. Conclusion All three countries demonstrate that excellent cancer care can and should be provided to all, including those who are impoverished or marginalized, without acceptance of a double standard. In this article, we call on governments and program leaders to report on successes and challenges in their own settings to allow for informed progression toward the 2025 global policy goals.

Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery

2016 ◽  
Vol 34 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Neo M. Tapela ◽  
Tharcisse Mpunga ◽  
Nadine Karema ◽  
Ignace Nzayisenga ◽  
Temidayo Fadelu ◽  
...  
Keyword(s):  
Implementation Science ◽  
Treatment Program ◽  
Cancer Care ◽  
Care Delivery ◽  
Scale Up ◽  
Cancer Center ◽  
Resource Constrained ◽  
Resource Limited ◽  
Set Up ◽  
Treatment Safety

Purpose The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science—the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed—is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. Methods The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. Results Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. Conclusion Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.

Moral Distress Among Oncology Social Workers

2021 ◽  
Vol 17 (7) ◽  
pp. e947-e957
Author(s):  
Ting Guan ◽  
Krista Nelson ◽  
Shirley Otis-Green ◽  
Makeeta Rayton ◽  
Tara Schapmire ◽  
...  
Keyword(s):  
Social Workers ◽  
Professional Education ◽  
Cancer Care ◽  
Healthcare Professionals ◽  
Moral Distress ◽  
Psychosocial Care ◽  
Average Score ◽  
Care Providers ◽  
Work Related ◽  
Oncology Social Workers

PURPOSE: Literature on moral distress among oncology social workers (OSWs) is sparse. The aim of the current study was to examine the prevalence of moral distress and its domains of influence, and to identify demographic and work-related characteristics associated with moral distress among OSWs. METHODS: Data came from the Oncology Social Work Competencies, Opportunities, Roles, and Expertise survey, conducted from August to September 2020 (during the COVID-19 global pandemic). Data collected included demographic information (eg, age, sex, and race) and work-related characteristics (eg, job position, organization type, work setting, employment status, salary, years in the profession, and OSW-C certification). Moral distress was measured using the Measure of Moral Distress for Healthcare Professionals. Tests of association, including multivariate linear regression, were conducted to achieve the research aims. RESULTS: Total moral distress scores on the Measure of Moral Distress for Healthcare Professionals (range 0-432) for 745 OSWs ranged from 1 to 273, with an average score of 74.0. The three highest indicators of moral distress were observed in the patient or family experience domain. Higher levels of moral distress were associated with younger age, being a direct service provider, provision of inpatient cancer care, and more years in the profession. CONCLUSION: OSWs are experiencing moral distress. Institutional investments in professional education and support of OSWs are needed to mitigate and possibly prevent moral distress experienced by cancer care providers and thus ensure the delivery of quality psychosocial care for patients with cancer and their families.

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