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

• DOI: 10.1371/journal.pone.0246716
• Publication Date: 2021-02-12T01:43:55Z
• Authors: Witness Mapanga; Shane A. Norris; Wenlong C. Chen; Charmaine Blanchard; Anita Graham; Laurel Baldwin-Ra...; Tom Boyles; Bernard Donde; Linda Greef; Ken Huddle; Busisiwe Khumalo; Elizabeth Leepile; Buhle Lubuzo; Raynolda Makhutle; Yusuf Mayet; Merika Tsitsi; Preethi Mistri; Keletso Mmoledi; Mpho Ratshikana-M...; Rajen Morer; Lauren Pretorius; Jayshina Punwasi; Guy A. Richards; Paul Ruff; Dineo Shabalala; Maureen Sibadela; Nita Soma; Michelle Wong; Maureen Joffe
• Keywords: Delphi Method

Lung cancer is the highest incident globally and associated with significant morbidity mortality particularly if identified at a late stage. Poor patient outcomes in low- middle-income countries (LMIC's) might reflect contextual health system constraints multiple levels, that act as barriers to prevention, disease recognition, diagnosis, treatment. screening, even for high-risk patients, not available public sector South Africa (SA), where current HIV tuberculosis (TB) epidemics often take precedence. Yet, there has been no formal assessment of individual health-system related may delay patients lung from seeking accessing help within care receiving appropriate effective diagnosis This study aimed derive consensus stakeholders urban Gauteng Province SA on most important challenges faced by services achieving optimum management identify potential solutions.The was undertaken among 27 participant representing clinical managers, clinicians, opinion leaders non-governmental organisation (NGO) representatives. The compromised two components: engagement. For component, Delphi Technique employed open-ended questions item ranking five rounds consensus-seeking, achieve collective agreement optimal management. engagement Nominal Group used articulate ideas reach an group's recommendations solution strategies approaches.Public suggested lack knowledge awareness cancer, apparent stigma its risk factors, well symptoms signs, are critical treatment delay. Furthermore, delays up-referral suspected district level were attributed inadequate arising in-service training nurses doctors regarding oncologic symptoms, need further investigation, interpretation x-rays treatments. At tertiary level, participants insufficient availability specialised diagnostic resources (imaging, cytological pathological including biomolecular cancer), theatres, cardiothoracic surgeons, therapeutic modalities (chemotherapeutic agents radiation oncology) main provision care. It primary prevention programme initiated government involves private-public partnerships improve nationally.Considerable early identification exist. Finding solutions overcome both obstacles screening vital facilitate treatment, survival. research inexpensive biomarkers asymptomatic detection, introduction imaging tools utilise artificial intelligence compensate human improving integration across all levels healthcare essential.