Atuhe Innocent, Jatho Alfred, Nalwadda Babra, Asasira Judith, Nantayi Martha, Semujju Joseph, Namwira Naome, Namayanja Kulusum, Atwine Ashley, Sekitene Semei Buwambaza, Orem Jackson
King Ceasar University, PO Box 88, Kampala, Uganda.
Newton & Einstein Institute of Science and Technology, PO Box 1330, Mbarara, Uganda.
Ecancermedicalscience. 2024 Jun 7;18:1712. doi: 10.3332/ecancer.2024.1712. eCollection 2024.
More than 50% of people with advanced cancer suffer from cancer-related cachexia (CC) - a major contributor to morbidity and mortality. Despite the lack of local guidelines on CC diagnosis and management in Uganda, the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO) and the Global Leadership Initiative on Malnutrition (GLIM) developed guidelines on CC screening and management. However, the level of knowledge on CC and compliance with the available guidelines among Ugandan oncology health professionals is unknown. This study aimed to assess the level of among (HCPs) involved in the care of cancer patients.
In this phase one, a self-administered structured questionnaire developed using the ASCO/ESMO and GLIM guidelines on diagnosis and management of CC was used to assess the level of awareness, and knowledge of 200 health professionals from three hospital settings on CC, and compliance with the ASCO/ESMO/GLIM guidelines on CC related core communication, barriers to communication, clinician training in communication, discussing goals of care, treatment options and meeting the needs of the underserved populations. The data were entered into Research Electronic Data Capture software analysed using STATA version 18.0 software.
The overall objectively correct knowledge score of CC diagnosis criteria was 67.5% ( = 135), yet there was a much lower level of awareness about ASCO/ESMO/GLIM guidelines on CC at 30% ( = 60) and only 21% ( = 42) of the HCPs have ever assessed Quality of life of CC patients. The compliance with ASCO/ESMO/GLIM guidelines on nutritional interventions for patients with CC varied across the variables markedly, ranging from 25.1% ( = 50) to 81% ( = 162) for the specific ASCO/ESMO/GLIM guidelines' recommendations. Whereas compliance with the guidelines on discussing goals of care, prognosis, treatment options and end-of-life care scored the highest in most variables, most HCPs exhibited low compliance with the discussion about patients' end-of-life preferences early in the course of incurable illness (49.8%, = 99). There were statistically significant differences between the mean scores of only two variables among the three hospitals in compliance with ASCO/ESMO/GLIM guidelines on the provision.
This study indicated that the overall objectively correct knowledge of CC diagnosis criteria was inadequate, with a much lower level of awareness about the ASCO/ESMO/GLIM guidelines on CC and a handful of the HCPs have ever assessed the quality of life of CC patients. Quality improvement interventions on CC diagnosis and management should prioritize improving the level of knowledge on CC, diagnostic criteria and patient-clinician communication, including discussion about patients' end-of-life care using standardised tools such as ASCO/ESMO or GLIM guidelines on CC using a multidisciplinary team approach.
超过50%的晚期癌症患者患有癌症相关性恶病质（CC），这是发病和死亡的主要原因。尽管乌干达缺乏关于CC诊断和管理的本地指南，但美国临床肿瘤学会（ASCO）、欧洲医学肿瘤学会（ESMO）和全球营养不良领导倡议组织（GLIM）制定了CC筛查和管理指南。然而，乌干达肿瘤健康专业人员对CC的了解程度以及对现有指南的遵循情况尚不清楚。本研究旨在评估参与癌症患者护理的医疗保健专业人员（HCPs）的相关水平。
在这个第一阶段，使用根据ASCO/ESMO和GLIM关于CC诊断和管理的指南开发的自填式结构化问卷，来评估来自三个医院环境的200名健康专业人员对CC的认识水平、知识以及对ASCO/ESMO/GLIM关于CC相关核心沟通、沟通障碍、沟通方面的临床医生培训、讨论护理目标、治疗选择和满足服务不足人群需求的指南的遵循情况。数据录入研究电子数据采集软件，使用STATA 18.0软件进行分析。
CC诊断标准的总体客观正确知识得分是67.5%（n = 135），然而对ASCO/ESMO/GLIM关于CC的指南的知晓水平要低得多，为30%（n = 60），只有21%（n = 42）的HCPs曾评估过CC患者的生活质量。HCPs对ASCO/ESMO/GLIM关于CC患者营养干预指南的遵循情况在不同变量间差异显著，特定ASCO/ESMO/GLIM指南建议的遵循率从25.1%（n = 50）到81%（n = 162）不等。虽然在大多数变量中，关于讨论护理目标、预后、治疗选择和临终护理的指南遵循率最高，但大多数HCPs在不可治愈疾病病程早期对患者临终偏好讨论的遵循率较低（49.8%，n = 99）。在提供方面，三家医院中只有两个变量的平均得分在遵循ASCO/ESMO/GLIM指南方面存在统计学显著差异。
本研究表明，对CC诊断标准的总体客观正确知识不足，对ASCO/ESMO/GLIM关于CC的指南的知晓水平低得多，只有少数HCPs曾评估过CC患者的生活质量。关于CC诊断和管理的质量改进干预措施应优先提高对CC、诊断标准以及医患沟通的知识水平，包括使用标准化工具（如ASCO/ESMO或GLIM关于CC的指南）通过多学科团队方法讨论患者的临终护理。
