Causes and Consequences of Chemotherapy Delays in Ambulatory Oncology Practices: A Multisite Qualitative Study

Lafferty, Megan; Fauer, Alex; Wright, Nathan; Manojlovich, Milisa; Friese, Christopher R.

doi:10.1188/20.onf.417-427

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…Possible reasons for this include the death of patients whilst on therapeutic intervention, their remission on completion of therapy, actual delays in treatment, and/or issues of affordability among patients with transport costs [ 45 , 78 , 79 ]. Treatment delays can also be due to laboratory testing processes, uncommunicated changes in day-of-treatment orders, discrepancies in care plans, delays of doctor instructions, and privation of covering to furnish for treatment financial outlay [ 80 ]. Overall, “14.9% of patients missed at least one scheduled appointment between March 2020 and December 2020 when the COVID-19” [ 60 ] constraints were in place, with similar outcomes regarding the pervasiveness of missed chemotherapy appointments.…”

Section: Discussionmentioning

confidence: 99%

The Disruptive Impact of COVID-19 on the Utilization of Cancer Chemotherapy-Related Healthcare Assistance at the Principal Nationwide Referral Hospital in Kenya

Njunge,

Okalebo,

Kurdi

et al. 2023

Cureus

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Background Lockdown measures to reduce the outbreak of COVID-19 negatively impacted the administration of cancer chemotherapy globally; however, data from Kenya are limited. Researchers strove to address this information gap and assess chemotherapy trends before and during the pandemic at Kenyatta National Hospital (KNH), the most wide-ranging referral infirmary in Kenya, along with associated factors to provide future guidance. Methods Time series analyses and patient interviews were undertaken at the KNH Cancer Treatment Centre. Patient data were analyzed descriptively and inferentially. The average quarterly scores of chemotherapy-related patients from January 2019 to December 2020 were computed for the time series analysis. Results A total of 241 participants were recruited. Of the participants, 164 (68%) were female, and the mean age was 55. Breast cancer was the most typical cancer type. Independent risk factors for missed chemotherapy sessions were a considerable increase in travel costs, rescheduled appointments alongside difficulties in securing an appointment, comorbidities, and marital status. There was a decline in chemotherapy utilization before COVID-19, with a sharp drop at the pandemic's peak. Conclusion COVID-19 and associated measures did appreciably affect the treatment of cancer patients with chemotherapy in this developing country, with several factors contributing to this. Efforts should be geared toward continuity of services during future pandemics in developing countries to improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

The Disruptive Impact of COVID-19 on the Utilization of Cancer Chemotherapy-Related Healthcare Assistance at the Principal Nationwide Referral Hospital in Kenya

Njunge,

Okalebo,

Kurdi

et al. 2023

Cureus

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“…Care coordination has been previously highlighted as challenging to achieve across the patient journey, and this study extends the understanding of coordination in ambulatory settings [ 20 , 21 , 40 , 46 ]. Issues raised elsewhere, such as the potential for the receipt of conflicting information and poor information flow, were also relevant in these settings [ 20 , 23 , 24 ]. Professionals in the study were acutely aware of potential pitfalls (e.g., double-checking the accuracy of information) and formed proactive strategies, including extending their capacity, to mitigate these risks.…”

Section: Discussionmentioning

confidence: 99%

“…Coordination is an ongoing challenge across the patient journey [ 21 , 22 ]. Prior research indicates there may be a lack of delineation of the specific roles that health professionals play in the team, there can be poor information flow between providers, and conflicting information may be provided to patients [ 20 , 23 , 24 ]. The professional responsible for the coordination of care can change in the course of care.…”

Section: Introductionmentioning

confidence: 99%

The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings

Easpaig

Tran

Winata

et al. 2022

BMC Health Serv Res

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Background Relatively little is understood about real-world provision of oncology care in ambulatory outpatient clinics (OPCs). This study aimed to: 1) develop an understanding of behaviours and practices inherent in the delivery of cancer services in OPC common areas by characterising the organisation and implementation of this care; and 2) identify barriers to, and facilitators of, the delivery of this care in OPC common areas. Methods A purpose-designed ethnographic study was employed in four public hospital OPCs. Informal field scoping activities were followed by in-situ observations, key informant interviews and document review. A view of OPCs as complex adaptive systems was used as a scaffold for the data collection and interpretation, with the intent of understanding ‘work as done’. Data were analysed using an adapted “Qualitative Rapid Appraisal, Rigorous Analysis” approach. Results Field observations were conducted over 135 h, interviews over 6.5 h and documents were reviewed. Analysis found six themes. Staff working in OPCs see themselves as part of small local teams and as part of a broader multidisciplinary care team. Professional role boundaries could be unclear in practice, as duties expanded to meet demand or to stop patients “falling through the cracks.” Formal care processes in OPCs were supported by relationships, social capital and informal, but invaluable, institutional expertise. Features of the clinic layout, such as the proximity of departments, affected professional interactions. Staff were aware of inter- and intra-service communication difficulties and employed strategies to minimise negative impacts on patients. We found that complexity, coordination, culture and capacity underpin the themes that characterise this care provision. Conclusions The study advances understanding of how multidisciplinary care is delivered in ambulatory settings and the factors which promote or inhibit effective care practice. Time pressures, communication challenges and competing priorities can pose barriers to care delivery. OPC care is facilitated by: self-organisation of participants; professional acumen; institutional knowledge; social ties and relationships between and within professional groups; and commitment to patient-centred care. An understanding of the realities of ‘work-as-done’ may help OPCs to sustain high-quality care in the face of escalating service demand.

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“…As proposed by Marcus (2015) , multi-sited ethnography initially relied on immersive fieldwork. However, many recent multi-site ethnographies examine and contextualize care delivery in various organizations ( Côté-Boileau et al, 2020 ; Lafferty et al, 2020 ; Leighton et al, 2020 ; van Belle et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Comparative Ethnographic Narrative Analysis Method: Comparing Culture in Narratives

Arnault

Šinko

2021

Global Qualitative Nursing Research

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Narrative data analysis aims to understand the stories’ content, structure, or function. However narrative data can also be used to examine how context influences self-concepts, relationship dynamics, and meaning-making. This methodological paper explores the potential of narrative analysis to discover and compare the processes by which culture shapes selfhood and meaning making. We describe the development of the Comparative Ethnographic Narrative Analysis Method as an analytic procedure to systematically compare narrators’ experiences, meaning making, decisions, and actions across cultures. This analytic strategy seeks to discover shared themes, examine culturally distinct themes, and illuminate meta-level cultural beliefs and values that link shared themes. We emphasize the need for a shared research question, comparable samples, shared non-biased instruments, and high-fidelity training if one uses this qualitative method for cross-cultural research. Finally, specific issues, trouble-shooting practices, and implications are discussed.

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Causes and Consequences of Chemotherapy Delays in Ambulatory Oncology Practices: A Multisite Qualitative Study

Cited by 6 publications

References 17 publications

The Disruptive Impact of COVID-19 on the Utilization of Cancer Chemotherapy-Related Healthcare Assistance at the Principal Nationwide Referral Hospital in Kenya

The Disruptive Impact of COVID-19 on the Utilization of Cancer Chemotherapy-Related Healthcare Assistance at the Principal Nationwide Referral Hospital in Kenya

The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings

Comparative Ethnographic Narrative Analysis Method: Comparing Culture in Narratives

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