Challenges and facilitators in pathways to cancer diagnosis in Southern Africa: a qualitative study

To explore healthcare workers' (HCWs) experiences, barriers and facilitators in managing patients with symptoms of possible breast, cervical or colorectal cancer.

A qualitative in-depth interview study with HCWs managing patients with breast, cervical and colorectal cancer symptoms. We also conducted workshops with a group of HCWs to check the credibility of the interview findings.

The study was conducted with staff working in primary, secondary and tertiary public health facilities in the Eastern and Western Cape in South Africa (SA), and Harare and Bulawayo and their referral provinces in Zimbabwe.

HCWs with experience in managing patients with symptoms of possible breast, cervical or colorectal cancer were recruited for the study. Participants were purposively sampled based on region, healthcare level and job role. A total of 56 participants (26 in SA and 30 in Zimbabwe) participated in the in-depth interviews. 26 (12 in SA and 14 in Zimbabwe) participated in four clinical advisory group workshops across both countries.

Drawing on the Model of Pathways to Treatment, HCWs' perceptions of patient-level factors influencing the diagnostic interval included financial limitations, patients' absence and delays in attendance. Healthcare provider and system factors included: challenges with referral and feedback systems; training needs; low awareness of protocols and guidelines; inappropriate and suboptimal clinical assessments; and broader socioeconomic factors and resource limitations.

Improving the timely diagnosis of breast, cervical and colorectal cancer in Southern Africa necessitates targeted strategies that address both patient-related, provider and health-system delays.