Chukwu Otuto Amarauche, Nnogo Chinenye Chidinma, Essue Beverley
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.
College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria.
Res Social Adm Pharm. 2023 Dec;19(12):1511-1519. doi: 10.1016/j.sapharm.2023.08.010. Epub 2023 Aug 29.
Cancer is a complex global health issue overburdening health systems especially in low- and middle-income countries (LMICs). This burden is becoming more severe and complex as the global shortage of cancer care workforce persists. Since task shifting offers an alternative to address workforce shortages, a systematic review with the following research question was carried out: What is the scope of roles and tasks shifted to nonphysician health workers in improving access to cancer control services? The aim of this review is to critically identify, appraise and present evidence on how task shifting could be integrated and scaled to expand access to quality cancer control services in LMICs.
The aim of this review is to critically identify, appraise and present evidence on how task shifting could be integrated and scaled to expand access to quality cancer control services in LMICs.
Four databases were searched - CINAHL, EMBASE, MEDLINE and SCOPUS from inception to October 15, 2022, and included all studies that reported task shifting of cancer control services to nonphysician health workers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines was followed to report the review process. Risk of bias was assessed using the National Heart, Lung, and Blood Institute quality assessment scale. The studies were summarized using narrative synthesis. A meta-analysis could not be carried out because the review only assessed the scope of roles that were shifted to nonphysician health workers and because of the heterogeneity in the characteristics of the studies included in the review.
The search identified 170 articles out of which 16 were included in the review. Three studies were randomized controlled trials, four were cluster randomized trials, while 9 were cross-sectional. Tasks were shifted to primary healthcare workers, nurses, and community health workers. Tasks shifted included screening, patient education, and diagnostic procedures. Evidence from the studies showed that the quality and effectiveness of tasks performed were comparable, and in some cases, better than usual care.
Findings showed that tasks in certain areas of cancer control services such as screening, education, and diagnosis can be shifted to nonphysician health workers and that it could be effective in improving access to certain cancer control services. Therefore, this review has shown that task shifting could be an effective strategy in addressing current workforce shortages in cancer care and that there is a need to examine the care required along the cancer continuum to better understand which interventions can most effectively be shifted to more advanced health professionals such as pharmacists to improve access to cancer control services in LMICs.
癌症是一个复杂的全球健康问题，给卫生系统带来了沉重负担，尤其是在低收入和中等收入国家（LMICs）。随着全球癌症护理劳动力短缺问题持续存在，这一负担正变得更加严峻和复杂。由于任务转移为解决劳动力短缺问题提供了一种替代方案，因此开展了一项具有以下研究问题的系统评价：转移给非医师卫生工作者以改善癌症控制服务可及性的角色和任务范围是什么？本评价的目的是严格识别、评估并呈现关于如何整合和扩大任务转移以在低收入和中等收入国家扩大优质癌症控制服务可及性的证据。
本评价的目的是严格识别、评估并呈现关于如何整合和扩大任务转移以在低收入和中等收入国家扩大优质癌症控制服务可及性的证据。
检索了四个数据库——CINAHL、EMBASE、MEDLINE和SCOPUS，检索时间从建库至2022年10月15日，纳入所有报告将癌症控制服务任务转移给非医师卫生工作者的研究。遵循系统评价和Meta分析的首选报告项目（PRISMA）2020指南报告评价过程。使用美国国立心肺血液研究所质量评估量表评估偏倚风险。采用叙述性综合法对研究进行总结。由于本评价仅评估转移给非医师卫生工作者的角色范围，且纳入评价的研究特征存在异质性，因此无法进行Meta分析。
检索共识别出170篇文章，其中16篇纳入本评价。三项研究为随机对照试验，四项为整群随机试验，九项为横断面研究。任务转移给了初级卫生保健工作者、护士和社区卫生工作者。转移的任务包括筛查、患者教育和诊断程序。研究证据表明，所执行任务的质量和效果具有可比性，在某些情况下，优于常规护理。
研究结果表明，癌症控制服务某些领域的任务，如筛查、教育和诊断，可以转移给非医师卫生工作者，并且这在改善某些癌症控制服务的可及性方面可能有效。因此，本评价表明任务转移可能是解决当前癌症护理劳动力短缺问题的有效策略，并且有必要审视癌症连续过程中所需的护理，以更好地了解哪些干预措施可以最有效地转移给更高级的卫生专业人员，如药剂师，以改善低收入和中等收入国家癌症控制服务的可及性。
