Identifying Barriers and Facilitators to the Improvement of Healthcare Delivery and Ethics in Two Cameroonian Neurosurgical Centers

Abstract

BackgroundLow-and middle-income countries (LMICs) are disproportionately affected by neurosurgical burden of disease. This health inequity causes constraints in decision-making. Neurosurgical ethics helps us to assess the moral acceptability and effectiveness of clinical decisions. We aimed to assess ethical neurosurgical care and its effect on patient satisfaction in Cameroon.MethodsTwo questionnaires hosted on Google Forms were administered among inpatients and staff at two Cameroonian neurosurgery centers. The questionnaires covered the factors influencing health outcomes and ethics. Data were collected from November 11, 2020, to March 11, 2021 and analyzed with SPSS v 26 to generate non-parametric tests with a threshold of significance at 0.05.ResultsSeventy patients and twenty healthcare providers responded to the survey. Most patients faced financial hardship (57.1%; 95% CI = 45.7–68.6%), and felt that this affected the care they received (P = 0.02). Patients noticed changes in the care plan and care delivery attributable to the neurosurgical units' lack of resources. According to the patients and caregivers, these changes happened 31.0–50.0% of the time (42.9%, 95% CI = 5.7–21.4%). The majority of patients were pleased with their involvement in the decision-making process (58.6%; 95% CI = 47.1–70.0%) and felt their autonomy was respected (87.1%; 95% CI = 78.6–94.3%).ConclusionMultiple challenges to neurosurgical ethical care were seen in our study. Multimodal interventions based on the four ethical principles discussed are necessary to improve ethical neurosurgical decision-making in this low resource setting.

Surgical informed consent practices and influencing factors in sub-Saharan Africa: a scoping review of the literature

“…In general, the most frequently explored implications of SIC were patients’ understanding of the procedure and risks involved36–47 (including recall of information as proxy27 48 49), autonomy in decision-making9 27 36 37 40 42 43 47 49–51 and satisfaction with the process 21 27 41 44–46 49 52–55…”

“…The published literature reported gaps in SIC practices across SSA countries and surgical subspecialties—from failure to routinely obtain consent for every surgery (eg, 49% compliance in Uganda9 and 55% in Ethiopia56) to overall inadequacy of the SIC process 36 47 52 55. A frequently documented issue, although in varying degrees, was the insufficient disclosure of information to patients, such as surgery’s details,21 36 57 who would perform it,21 36 55 alternative choices,36 52 anaesthesia type,36 45 52 55 potential risks36 42 45 47 55 and postsurgery management steps 37…”

“…One factor influencing SIC that was well documented in the literature was the education and literacy level of patients. A lower level of education was found to be related to a poorer understanding of medical terms47 and explanations,27 37 40 and the consent process43; less adequate subjective consent36 and satisfaction with the process 44 53. This was reported as a major barrier in patient–provider communication 37 40…”

“…In particular, it is advocated that personalised communication, as opposed to top‐down exposition or standardised interactions, should take place between the provider and the patient to maximise patient understanding 37 61. A range of interventions to improve patients’ comprehension in SIC has been reported, but the evidence to date is very heterogeneous and Western centred (only one study from Africa) 8.…”

“…In general, the most frequently explored implications of SIC were patients' understanding of the procedure and risks involved [36][37][38][39][40][41][42][43][44][45][46][47] (including recall of information as proxy 27 48 49 ), autonomy in decisionmaking 9 27 36 37 40 42 43 47 49-51 and satisfaction with the process. 21 27 41 44-46 49 52-55 Given the heterogeneous nature of the body of evidence retrieved, it was not possible to perform a quantitative comparison, hence the following sections provide a synthesis of key themes from the literature.…”