Trabitzsch Josephin, Marquardt Morena, Negash Sarah, Belay Winini, Abebe Yonas, Seife Edom, Abdella Kunuz, Gizaw Muluken, Getachew Sefonias, Addissie Adamu, Kantelhardt Eva Johanna, Wondimagegnehu Abigiya
Global Health Working Group, Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstraße 8, 06112, Halle (Saale), Germany.
Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Cancer. 2024 May 2;24(1):553. doi: 10.1186/s12885-024-12294-7.
Cancer incidence is increasing in Ethiopia mainly due to increased life expectancy, while oncological capacities remain limited. Strong referral linkages between different levels of the healthcare system are key to provide timely access to cancer care. In this qualitative study, we assessed limitations and potential of cancer patient referral in the rural Southwest of Ethiopia.
We held four focus group discussions (FGD) with health professionals at one primary and three secondary hospitals and conducted eight in-depth interviews (IDI) with the hospitals´ medical executives and local health bureau representatives. Data was analysed inductively using thematic analysis and emerging themes were categorized within the revised concept of access by Penchansky and Saurman.
The inevitable referral of patients with cancer in the rural Southwest of Ethiopia is characterized by the absence of clear communication protocols and the lack of formal referral linkages. The newly implemented hub-system has improved emergency referrals and could be expanded to non-emergency referrals, sensitive to the needs of advanced oncological care. Liaison officers can pave the way but need to be trained and equipped adequately. Referred patients struggle with inadequate transportation systems, the lack of accommodation close to specialized facilities as well as the inability to navigate at those sites due to language barriers, illiteracy, and stigmatization. Few Non-Governmental Organizations (NGOs) help but cannot compensate the limited governmental support. The shortage of medications at public hospitals leads to patients being directed to costly private pharmacies. In the light of those challenges, cancer remains to be perceived as a "death sentence" within the rural communities.
Standardized referral linkages and a multi-faceted support network throughout the cancer care continuum are necessary to make oncology care accessible to Ethiopia´s large rural population.
埃塞俄比亚的癌症发病率不断上升，主要原因是预期寿命增加，而肿瘤治疗能力仍然有限。医疗保健系统不同层级之间强大的转诊联系是及时获得癌症治疗的关键。在这项定性研究中，我们评估了埃塞俄比亚西南部农村地区癌症患者转诊的局限性和潜力。
我们在一家基层医院和三家二级医院与卫生专业人员进行了四次焦点小组讨论（FGD），并对医院的医疗管理人员和当地卫生局代表进行了八次深入访谈（IDI）。使用主题分析法对数据进行归纳分析，并将新出现的主题按照Penchansky和Saurman修订后的可及性概念进行分类。
埃塞俄比亚西南部农村地区癌症患者不可避免的转诊特点是缺乏明确的沟通协议以及正式的转诊联系。新实施的中心系统改善了紧急转诊情况，并且可以扩展到非紧急转诊，以满足高级肿瘤治疗的需求。联络官可以起到推动作用，但需要得到充分的培训和配备。转诊患者面临交通系统不完善、缺乏靠近专科医院的住宿以及由于语言障碍、文盲和污名化而无法在这些场所导航等问题。很少有非政府组织提供帮助，但无法弥补政府支持的不足。公立医院药品短缺导致患者被导向昂贵的私人药店。鉴于这些挑战，癌症在农村社区仍被视为“死刑判决”。
需要标准化的转诊联系以及贯穿癌症治疗全过程的多方面支持网络，以使埃塞俄比亚广大农村人口能够获得肿瘤治疗。
