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Perceived barriers to timely treatment initiation and social support status among women with breast cancer in Ethiopia.

ABSTRACT: Timely care is essential to increase breast cancer survival. However, patients in Ethiopia still face multilevel barriers on their pathway to timely treatment initiation. This cross-sectional study at Tikur Anbessa Specialized Hospital Oncology Unit in Addis Ababa assessed systemic treatment initiation intervals of breast cancer patients and quantified the impact of socio-demographic and clinical factors, perceived barriers, and the patients´ perceived social support status on timely systemic treatment initiation (chemotherapy or hormonal therapy). A structured questionnaire was designed based on Pechansky´s "Concept of Access". Applying simple and multivariate logistic regression we analysed the influence of patients´ characteristics as well as their perceived barriers on timely treatment initiation. We measured social support with the Multidimensional Score of Perceived Social Support (MSPSS) and used the Wilcoxon Rank-Sum Test to assess its relationship with timely treatment initiation. Of 196 patients included into the study, 53% received systemic treatment within 90 days of their pathological diagnosis-the median treatment initiation interval was 85 days (IQR 123.5). Older women and patients diagnosed at late stages had higher odds of timely treatment initiation. Not being able to pay for services and lack of transport were most often perceived as barriers towards timely care. However, none of the perceived barriers showed a substantial influence on timely treatment initiation in the multivariate regression model. The patients´ perceived social support was found to be high, with an average MSPSS score of 73 out of 84 (SD 13,63). No impact of the perceived social support status on timely treatment initiation was found. The percentage of breast cancer patients waiting longer than 90 days from pathological diagnosis to systemic treatment initiation in Ethiopia remains unacceptably high. While women generally feel well supported by their social environment, costs and accessibility of treatment are perceived to be major barriers towards timely treatment initiation.

SUBMITTER: Teshome B

PROVIDER: S-EPMC8437283 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:RATIONALE:Social support plays an important role in quality of life and health outcomes after breast cancer diagnosis and treatment. OBJECTIVE:To examine changes in perceived social support in African American women during the two years following a new breast cancer diagnosis. METHODS:This secondary analysis uses data collected from 2009 to 2015 from 227 newly diagnosed, African American women with breast cancer (mean age 56 [SD = 10], 59% household income < $25,000; 28% married/partnered, 72% early stage) participating in a randomized controlled trial testing the effects of a video-communication intervention on quality-of-life and follow-up care. Participants, all of whom received treatment in one metropolitan area of the Midwestern United States, completed five telephone interviews over 2-year follow-up; demographic, psychosocial, quality of life, and clinical data were collected. Growth curve models were used to examine change in perceived social support (measured by the Medical Outcomes Study Social Support Survey) as well as correlates of baseline levels of social support and predictors of change in individuals' social support. Additional analyses examined whether change in social support over the first year affected depressive symptoms (Center for Epidemiologic Studies Depression Scale) and general health perceptions (RAND SF-36 subscale) at two years. RESULTS:Being married, reporting greater spirituality, and reporting fewer depressive symptoms at baseline were significantly associated with higher initial levels of perceived social support. Women whose social support declined during the first year after diagnosis reported more severe depressive symptoms and worse general health perceptions at two years. CONCLUSION:Clinicians should periodically assess perceived social support among African American women with breast cancer to help find support resources for those who have low initial social support and for those whose support declines in the first year after diagnosis.

Project description:BACKGROUND:Depression is a common co-morbid, disabling disorder that affects 10-25% of cancer patients. It causes substantial functional impairment and lowers survival rate of breast cancer patients. Therefore, the aim of this study is to determine the magnitude of depression and its association with social support among breast cancer patients in Addis Ababa, Ethiopia. METHODS:A cross-sectional study which included 428 breast cancer patients was conducted in seven health facilities in Addis Ababa, Ethiopia. Depression and Social Support were assessed using standard tools Patient Health Questionnaire 9 (PHQ 9) and Multidimensional Scale of Perceived Social Support (MSPSS) respectively. Descriptive statistics were done based on the standard PHQ9 cut off points (0-4, 5-9, 10-14, 15-19 and???20). Mann-Whitney and Kruskal Wallis tests were employed to compare MSPSS score among depressed and non-depressed patients and across the different levels of depression. Bivariate and multivariate logistic regression was done to identify factors associated with depression. RESULT:The prevalence of depression among breast cancer patients was 25% (107/428), andaccording to the PHQ9 score categorization, 70/428 (16.4%), 30/428 (7.01%) and 7/428 (1.64%) of these patients were having moderate, moderately severe and severe depression respectively. Age, occupation, type of health facility treated, severity of pain, hormonal therapy and having problem with employer/ family were significantly associated with depression. The participants' MSPSS total score was overall found to be high (70.35?±?16.81). Those women who had moderate and severe depression had lower mean MSPSS scores compared to women with none/ minimal depression (P =?0.002). CONCLUSION:This study found that one in four breast cancer patients had depression. Depression is associated with poor social support given by family, friends and significant others. Therefore, screening for depression and psychosocial service should be integrated in the routine breast cancer care in Ethiopia.

Project description:BackgroundSpontaneous breathing trials (SBTs) are an evidence-based way of identifying patients ready for mechanical ventilation (MV) liberation. Despite their effectiveness, global SBT performance rates remain suboptimal, and many patients who demonstrate the ability to breathe on their own remain on MV. The factors that influence clinicians' decision to discontinue MV following a successful SBT remain unclear.AimsThe aim of this study was to explore the underlying causes of extubation delays in the intensive care unit (ICU) from an interprofessional perspective.MethodsAn exploratory, descriptive, cross-sectional design was used. An online survey was administered in December 2019 to clinicians practicing in three ICUs at a single medical center in the U.S. Survey questions focused on clinicians' perceptions of current MV liberation practices and perceived barriers or facilitators to timely extubation after a successful SBT.ResultsOf 425 eligible clinicians, 135 completed the survey (31.7% response rate). The majority of clinicians believed the current SBT and extubation process took too long (n = 108; 80.0%) and that this delay negatively affected patient outcomes. While professional groups differed in their rankings of importance, factors perceived to contribute to extubation delays most commonly included SBT timing, low provider confidence levels in making extubation decisions, and patient-specific factors. Potential strategies to overcome these barriers included developing an automated extubation protocol, performing SBTs when the provider responsible for final extubation decisions is physically present, and decreasing clinician perception of reprimand or condemnation for failed extubations.Linking evidence to actionThe MV liberation process is complex and dependent on the decisions of various ICU professionals. Clinicians perceive a number of potentially modifiable provider- and organizational-level factors that cause extubation delays in everyday practice. Understanding and addressing these barriers is essential for improving ICU quality and patient outcomes. Future research should explore the effect of nurse and respiratory therapist-driven extubation protocols on MV liberation rates.

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Perceived barriers to timely treatment initiation and social support status among women with breast cancer in Ethiopia.

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