Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania – Nyagabona – – The Oncologist
In response to the increasing cancer burden in Tanzania, the Ministry of Health, Community Development, Gender, Elderly and Children launched National Cancer Treatment Guidelines (TNCTG) in February 2020. The guidelines were intended to improve and standardize oncology care in the country. At Ocean Road Cancer Institute (ORCI), we have developed a theory-based implementation strategy to promote guideline consistent care. As part of the situation analysis for the development of implementation strategies, we held focus group discussions to evaluate clinical systems and contextual factors influencing guideline-based practices prior to the launch of TNCTG.
In June 2019, three focus group discussions were held with a total of 21 oncology doctors from ORCI, stratified by profession. A discussion guide was used to stimulate dialogue about facilitators and obstacles to the delivery of guideline-consistent care. Discussions were recorded with audio, transcribed, translated, and analyzed using thematic framework analysis.
Participants identified factors both within the internal context of ORCI clinical systems and outside ORCI. Themes within the clinical systems included: capacity and infrastructure, information technology, communication, efficiency and quality of the services provided. Contextual factors outside ORCI included: inter-institutional coordination, oncology capacity in peripheral hospitals, public awareness and beliefs, and financial barriers. Participants provided pragmatic suggestions to strengthen cancer care delivery in Tanzania.
Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect TNCTG uptake. Our findings were used to develop a broader guideline implementation strategy, in an effort to improve the acceptance of the TNCTGs at ORCI.
Implications for practice
This study provides an assessment of cancer care delivery systems in a resource-poor environment from the unique perspectives of local multidisciplinary oncology clinicians. Situational analysis of contextual factors likely to influence outcomes of guideline implementation is the first step in developing an implementation strategy for cancer treatment guidelines. Many of the barriers identified in this study represent action-oriented goals that will form the next phases of our implementation strategy for guideline-consistent cancer care in Tanzania and similar environments.