Consensus study on the health system and patient-related barriers for lung cancer management in South Africa

• Published in: PloS one 2021-02, Vol.16 (2), p.e0246716
• Main Authors: Mapanga, Witness, Norris, Shane A, Chen, Wenlong C, Blanchard, Charmaine, Graham, Anita, Baldwin-Ragaven, Laurel, Boyles, Tom, Donde, Bernard, Greef, Linda, Huddle, Ken, Khumalo, Busisiwe, Leepile, Elizabeth, Lubuzo, Buhle, Makhutle, Raynolda, Mayet, Yusuf, Tsitsi, Merika, Mistri, Preethi, Mmoledi, Keletso, Ratshikana-Moloko, Mpho, Morer, Rajen, Pretorius, Lauren, Punwasi, Jayshina, Richards, Guy A, Ruff, Paul, Shabalala, Dineo, Sibadela, Maureen, Soma, Nita, Wong, Michelle, Joffe, Maureen
• Format: Article
• Language: English
• Subjects: Artificial intelligence; Auroral kilometric radiation; Biomarkers; Cancer therapies; Care and treatment; Clinical medicine; Consortia; Data analysis; Diagnosis; Diagnostic software; Diagnostic systems; Disease; Disease detection; Diseases; Editing; Electronic mail; Fossils; Health care; Health risks; Health sciences; Health services; Hospitals; Human resources; Hygiene; Internal medicine; Lung cancer; Lung diseases; Medical diagnosis; Medical electronics; Medical personnel; Medical research; Medical screening; Medicine; Medicine and Health Sciences; Methodology; Morbidity; Nursing; Oncology; Palliative care; Patients; Pediatrics; Physicians; Primary care; Public health; Radiation; Radiation therapy; Risk analysis; Risk factors; Signs and symptoms; Variance analysis; Visualization
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0246716

Lung cancer is the highest incident cancer globally and is associated with significant morbidity and mortality particularly if identified at a late stage. Poor patient outcomes in low- and middle-income countries (LMIC's) might reflect contextual patient and health system constraints at multiple levels, that act as barriers to prevention, disease recognition, diagnosis, and treatment. Lung cancer screening, even for high-risk patients, is not available in the public health sector in South Africa (SA), where the current HIV and tuberculosis (TB) epidemics often take precedence. Yet, there has been no formal assessment of the individual and health-system related barriers that may delay patients with lung cancer from seeking and accessing help within the public health care system and receiving the appropriate and effective diagnosis and treatment. This study aimed to derive consensus from health-system stakeholders in the urban Gauteng Province of SA on the most important challenges faced by the health services and patients in achieving optimum lung cancer management and to identify potential solutions. The study was undertaken among 27 participant stakeholders representing clinical managers, clinicians, opinion leaders from the public health sector and non-governmental organisation (NGO) representatives. The study compromised two components: consensus and engagement. For the consensus component, the Delphi Technique was employed with open-ended questions and item ranking from five rounds of consensus-seeking, to achieve collective agreement on the most important challenges faced by patients and the health services in achieving optimal lung cancer management. For the engagement component, the Nominal Group Technique was used to articulate ideas and reach an agreement on the group's recommendations for solution strategies and approaches. Public health sector stakeholders suggested that a lack of knowledge and awareness of lung cancer, and the apparent stigma associated with the disease and its risk factors, as well as symptoms and signs, are critical to treatment delay. Furthermore, delays in up-referral of patients with suspected lung cancer from district health care level were attributed to inadequate knowledge arising from a lack of in-service training of nurses and doctors regarding oncologic symptoms, risk factors, need for further investigation, interpretation of x-rays and available treatments. At a tertiary level, participants suggested that insufficie