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A Step Toward Timely Referral and Early Diagnosis of Cancer: Implementation and Impact on Knowledge of a Primary Care-Based Training Program in Botswana

Authors :
Neo M. Tapela
Michael J. Peluso
Racquel E. Kohler
Irene I. Setlhako
Kerapetse Botebele
Kemiso Gabegwe
Isaac Nkele
Mohan Narasimhamurthy
Mompati Mmalane
Surbhi Grover
Tomer Barak
Lawrence N. Shulman
Shahin Lockman
Scott Dryden-Peterson
Source :
Frontiers in Oncology, Vol 8 (2018)
Publication Year :
2018
Publisher :
Frontiers Media S.A., 2018.

Abstract

IntroductionHealth system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and median time from first health facility visit for cancer-related symptoms to specialty cancer care was 160 days (IQR 59–653). We describe the implementation and early outcomes of training targeting primary care providers, which is a part of a multi-component implementation study in Kweneng-East district aiming to enhance timely diagnosis of cancers.MethodsHealth-care providers from all public facilities within the district were invited to participate in an 8-h intensive short-course program developed by a multidisciplinary team and adapted to the Botswana health system context. Participants’ performance was assessed using a 25-multiple choice question tool, with pre- and post-assessments paired by anonymous identifier. Statistical analysis with Wilcoxon signed-rank test to compare performance at the two time points across eight sub-domains (pathophysiology, epidemiology, social context, symptoms, evaluation, treatment, documentation, follow-up). Linear regression and negative binomial modeling were used to determine change in performance. Participants’ satisfaction with the program was measured on a separate survey using a 5-point Likert scale.Results176 participants attended the training over 5 days in April 2016. Pooled linear regression controlling for test version showed an overall performance increase of 16.8% after participation (95% CI 15.2–18.4). Statistically significant improvement was observed for seven out of eight subdomains on test A and all eight subdomains on test B. Overall, 71 (40.3%) trainees achieved a score greater than 70% on the pretest, and 161 (91.5%) did so on the posttest. Participants reported a high degree of satisfaction with the training program’s content and its relevance to their daily work.ConclusionWe describe a successfully implemented primary health care provider-focused training component of an innovative intervention aiming to reduce health systems delays in cancer diagnosis in sub-Saharan Africa. The training achieved district-wide participation, and improvement in the knowledge of primary health-care providers in this setting.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT02752061.

Details

Language :
English
ISSN :
2234943X
Volume :
8
Database :
Directory of Open Access Journals
Journal :
Frontiers in Oncology
Publication Type :
Academic Journal
Accession number :
edsdoj.57d4ef7686d34cdfb6cd8ef07fa07925
Document Type :
article
Full Text :
https://doi.org/10.3389/fonc.2018.00187