Investigating Cancer Treatment Pathways and Guideline Adoption in Nigeria
Overview
This qualitative study explored barriers and facilitators affecting the implementation of NCCN harmonized cancer survivorship guidelines in Nigeria. Key challenges identified include human resource shortages, financial constraints, and limited guideline awareness, while strong communication and existing infrastructure were potential facilitators. Social, religious, and caregiver roles also significantly influenced guideline adoption.
Background
Cancer survivorship care addresses long-term health monitoring and psychosocial wellbeing post-treatment, distinct from palliative care which focuses on symptom management and end-of-life care. In sub-Saharan Africa, survivorship strategies have largely emphasized palliative care, with limited measurable indicators for survivorship services. The NCCN developed resource-stratified harmonized survivorship guidelines for sub-Saharan Africa to support comprehensive care, but contextual factors in Nigeria may affect their implementation. Understanding these factors is critical to adapting guidelines to local needs and improving patient outcomes.
Data Highlights
The study conducted interviews with 22 key informants: 9 patients, 9 healthcare providers, and 4 caregivers. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) domains, focusing on inner setting, outer setting, intervention characteristics, and individual characteristics to identify barriers and facilitators to guideline implementation.
Key Findings
Healthcare providers identified human resource shortages, financial constraints, and limited awareness of NCCN guidelines as major barriers to implementation.
Strong communication practices and existing healthcare infrastructure were seen as facilitators supporting guideline adoption.
Patients and caregivers highlighted social and religious influences that could either support or hinder guideline implementation.
Financial hardship was the most prominent barrier reported by patients and caregivers affecting access to survivorship care.
The central role of caregivers was recognized as critical in shaping patient experiences and supporting survivorship care.
Context-specific adaptations of guidelines are necessary to address local resource limitations and cultural factors effectively.
Clinical Implications
Clinicians and policymakers should consider financial barriers and resource constraints when implementing survivorship guidelines in Nigeria. Leveraging strong communication channels and involving caregivers and faith-based networks can enhance guideline uptake. Tailoring survivorship care to the sociocultural context is essential for improving patient adherence and outcomes.
Conclusion
The study highlights the importance of context-specific strategies to implement cancer survivorship guidelines in Nigeria. Addressing financial, social, and organizational factors can facilitate better integration of evidence-based survivorship care in resource-limited settings.
References
Garton et al. 2023 -- Investigating Cancer Treatment Pathways and Contextual Factors Affecting Guideline Adoption in Nigeria
