Touro University California, Vallejo, CA, USA.
Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Reprod Health. 2022 Jan 4;19(1):2. doi: 10.1186/s12978-021-01316-3.
Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country's first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical.
This qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women's and providers' perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data.
Providers lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking.
In-service provider training should be intensified and should include discussions of cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities are also a priority. Expanded cervical cancer health education should focus on stigma reduction and emphasize a broad, wide-spread risk of cervical cancer.
宫颈癌是埃塞俄比亚女性中第二大常见的癌症，每年约有 4700 名女性因此死亡。随着政府推出该国首个国家癌症控制战略，了解患者和医护人员在接受和提供宫颈癌筛查、诊断和治疗方面的经验至关重要。
本定性研究旨在评估宫颈癌护理的可及性；探讨护理障碍和延迟的原因；并描述女性和医护人员对护理的看法和体验。我们分析了在东戈贾姆地区的 16 个卫生中心、区医院和转诊医院以及亚的斯亚贝巴的一个支持中心收集的 45 名受访者的数据。采访了 30 名医护人员和 10 名正在接受护理的女性，5 名正在治疗或治疗后的女性参加了焦点小组讨论。使用演绎和归纳代码对数据进行主题分析。
医护人员缺乏筛查和治疗患者的设备和空间，只有 16%接受过宫颈癌在职培训。因此，很少有设施提供筛查或预防治疗。患者报告的风险认知度低、耻辱感高、缺乏宫颈癌知识以及护理启动延迟。除了一名患者外，所有患者都是在出现症状时才寻求护理，而且在诊断前，只有一半的患者了解宫颈癌。即使在那些知道宫颈癌的患者中，许多人也认为自己没有风险，因为她们没有性行为。误诊是一半患者经历的另一个常见延迟原因。一旦确诊，女性需要等待数月才能转诊，而一旦开始治疗，设备故障和医院病床短缺会导致更多的延迟。治疗性治疗的障碍包括缺乏住房和旅行资金。医护人员与患者沟通癌症诊断的情况往往不足。
应加强医护人员的在职培训，包括讨论宫颈癌症状。优先考虑将筛查和诊断用品更好地分配到基层设施，并更好地维护三级设施的治疗设备。扩大宫颈癌健康教育应侧重于减少耻辱感，并强调宫颈癌的广泛风险。
