Burrowes Sahai, Seyoum Alemu Hanamariam, Khokhar Natasha, McMillian Genevive, Hamade Souad, Dmitriyev Roman, Pham Khoa, Whitney Sarah, Galew Baye, Mahmoud Eiman, Hernandez Alexandra Lydia
College of Health Sciences, Public Health Program, Touro University California, Vallejo, CA, USA.
Center for Gender Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2025 May 7;25(1):652. doi: 10.1186/s12913-025-12778-7.
As Ethiopia expands cervical cancer screening services, it urgently needs information to develop appropriate post-screening diagnostic and treatment services for women with abnormal results. Quality cancer care requires extensive coordination among multidisciplinary provider teams. This study explores experiences coordinating care among providers at multiple levels of the cancer-care continuum in Ethiopia.
From February 2020 to January 2022, we conducted four focus group discussions (FGDs) and ten key-informant interviews with 34 purposively selected healthcare providers: health extension workers (HEWs) in communities; midwives and nurses at health centers; obstetrician-gynecologists at regional hospitals, and oncology nurses, oncologists, and pathologists at tertiary hospitals. FGDs and interviews were conducted in Amharic and audio-recorded. Audio transcripts were then simultaneously transcribed and translated into English for analysis. Investigators performed thematic analysis using inductive and deductive codes.
We found four themes: resource scarcity, care centralization, lack of formal coordination mechanisms, and recommendations. Themes were dynamically connected by eight sub-themes. Providers valued teamwork and coordination. However, severe shortages of cancer specialists and high patient loads left little time for communication and hampered the formation of stable care teams. Facilities lacked formal coordination systems, such as patient navigators and case managers. The relative centralization of cancer care specialists and equipment in the capital exacerbated coordination problems. It impeded pre- and post-treatment care communication between tertiary and secondary facilities and caused secondary facilities to unnecessarily refer patients because they lacked the resources to treat them locally. Referral communication was unidirectional, with lower-level providers communicating regularly to higher-level facilities but rarely receiving feedback. The exception was regular, structured feedback from primary facilities to HEWs. Lower-level providers wanted to learn whether their referrals were appropriate or completed, and many used informal channels to gain this information. Respondents recommend decentralizing cancer care services, significantly increasing staff and equipment investments, and adding liaison staff at secondary hospitals to track and communicate patient progress and counsel patients for referral.
Our findings underscore the need to rapidly increase cancer specialist staff and regional cancer centers in Ethiopia and highlight the importance of developing robust coordination and feedback mechanisms at secondary and tertiary facilities.
随着埃塞俄比亚扩大宫颈癌筛查服务，该国迫切需要信息来为检查结果异常的女性制定适当的筛查后诊断和治疗服务。高质量的癌症护理需要多学科医疗团队之间进行广泛协调。本研究探讨了埃塞俄比亚癌症护理连续统一体多个层面的医疗服务提供者之间协调护理的经验。
2020年2月至2022年1月，我们进行了四次焦点小组讨论（FGD），并对34名经过有目的挑选的医疗服务提供者进行了十次关键信息人访谈：社区的健康推广工作者（HEW）；健康中心的助产士和护士；地区医院的妇产科医生，以及三级医院的肿瘤护士、肿瘤学家和病理学家。焦点小组讨论和访谈用阿姆哈拉语进行，并进行了录音。然后将音频转录本同时转录并翻译成英文进行分析。研究人员使用归纳和演绎编码进行主题分析。
我们发现了四个主题：资源稀缺、护理集中化、缺乏正式协调机制以及建议。这些主题由八个子主题动态连接。医疗服务提供者重视团队合作和协调。然而，癌症专科医生严重短缺以及患者数量众多，导致几乎没有时间进行沟通，阻碍了稳定护理团队的形成。医疗机构缺乏正式的协调系统，如患者导航员和病例管理人员。癌症护理专家和设备相对集中在首都加剧了协调问题。这阻碍了三级和二级医疗机构之间治疗前和治疗后的护理沟通，并导致二级医疗机构因缺乏在当地治疗患者的资源而不必要地转诊患者。转诊沟通是单向的，低级别的医疗服务提供者定期与高级别的医疗机构沟通，但很少收到反馈。唯一的例外是初级医疗机构向健康推广工作者提供定期、结构化的反馈。低级别的医疗服务提供者想了解他们的转诊是否合适或已完成，许多人通过非正式渠道获取这些信息。受访者建议将癌症护理服务去中心化，大幅增加人员和设备投资，并在二级医院增加联络人员，以跟踪和沟通患者进展情况，并为患者提供转诊咨询。
我们的研究结果强调了埃塞俄比亚迅速增加癌症专科医生和地区癌症中心的必要性，并突出了在二级和三级医疗机构建立强大的协调和反馈机制的重要性。
