Faculty of Medicine, Braun School of Public Health Community Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel.
Department of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
JCO Glob Oncol. 2023 Sep;9:e2300104. doi: 10.1200/GO.23.00104.
Cancer care in low-income countries poses formidable challenges. Care may be facilitated by resource-adapted guidelines, such as the National Comprehensive Cancer Network (NCCN) harmonized guidelines for sub-Saharan Africa (NCCN-HG). Understanding physicians' attitudes and knowledge toward guidelines, as well as patient- and resource-related barriers, is essential for promoting their effective implementation.
We conducted an online survey among oncologists, hematologists, internists, residents/fellows, and generalists treating hematologic malignancies in Ethiopia. We assessed attitudes toward the use of guidelines, institutional capacity, and barriers/determinants to effective care.
Among the 47 physicians completing the survey (representing 64% of Ethiopian professionals treating hematologic malignancies), the majority (85%) reported using guidelines; however, only 22.7% (n = 10) used the NCCN-HG. While overall attitudes toward guidelines were favorable, 57.8% of physicians familiar with the NCCN-HG were either undecided or believed that it lowers the standard of care. Perceived lack of institutional regulation was negatively associated with guideline use ( = -3.23; = .004). Lack of diagnostic facilities including immunohistochemistry and flow cytometry, supportive care, and poor utilization of guidelines were reported to be determinants of poor patient outcome. Regarding patient factors, 57.4% respondents identified treatment abandonment as an important contributor to poor outcome. Availability of chemotherapy/radiotherapy (89.4%), financial status (85.1%), distance from the hospital (74.5%), and harvest season (65%) had major influences on treatment decisions. Over 80% reported that targeted therapies were unavailable or rarely available.
Awareness and usage of the NCCN-HG are limited among Ethiopian physicians. Lack of facilities, therapies, and regulation, in addition to patient-related factors, was identified as barriers to guideline adherence and determinants of poor outcome.
在低收入国家提供癌症护理面临巨大挑战。资源适应指南可以为护理提供便利，例如国家综合癌症网络（NCCN）为撒哈拉以南非洲制定的协调指南（NCCN-HG）。了解医生对指南的态度和知识，以及患者和资源相关的障碍，对于促进其有效实施至关重要。
我们对在埃塞俄比亚治疗血液恶性肿瘤的肿瘤学家、血液学家、内科医生、住院医师/研究员和全科医生进行了在线调查。我们评估了对指南使用的态度、机构能力以及有效护理的障碍/决定因素。
在完成调查的 47 名医生中（代表了 64%治疗血液恶性肿瘤的埃塞俄比亚专业人员），大多数（85%）报告使用了指南；然而，只有 22.7%（n=10）使用了 NCCN-HG。尽管对指南的总体态度是有利的，但 57.8%熟悉 NCCN-HG 的医生持不确定或认为它降低了护理标准。机构监管不足被认为与指南的使用呈负相关（ = -3.23； =.004）。缺乏诊断设施，包括免疫组织化学和流式细胞术、支持性护理以及对指南的利用不足，被认为是患者预后不良的决定因素。关于患者因素，57.4%的受访者认为治疗放弃是导致不良结局的重要原因。化疗/放疗的可及性（89.4%）、财务状况（85.1%）、距医院的距离（74.5%）和收获季节（65%）对治疗决策有重大影响。超过 80%的受访者表示，靶向治疗药物不可用或很少可用。
埃塞俄比亚医生对 NCCN-HG 的认识和使用有限。缺乏设施、治疗方法和监管，以及患者相关因素，被认为是遵医嘱的障碍和不良结局的决定因素。
