Skip to main content

Table 2 Main factors (barriers and facilitators) identified across studies

From: Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

Author Main finding WHO building blocks addressed
Quantitative research
Barriers
Facilitators
Qualitative research
Barriers
Facilitators
 
Lydia E. Pace et al. 2015 - Delayed Referral NA - Delayed referral
- Delayed Administrative procedures (transfer form)
- Provider misinformation
NA - Service delivery
- Health workforce
- Information systems
Maureen Joffe et al. 2018 - Delayed Referral (
- Delayed appointment or test results
- Misdiagnosis
NA NA   - Service delivery
- Health workforce
Sultane Sherman and Vincent Okungu 2018 NA NA - Long waiting periods to see an oncologist
- Need to travel long distances to get diagnosis and treatment services
- Lack of specialist service
- Persistent breakdown of radiotherapy machines
- High cost of treatment and lack of insurance
NA - Service delivery
- Health financing
- Technologies
- Governance
Grosse Frie K et al. 2018 - Facility and type of medical doctor at the first healthcare facility visited: community care centre or a generalist
- No diagnosis or misdiagnosis
- Having no health insurance
Being referred by
by an oncologist or surgeon
NA NA - Service delivery
- Health workforce
- Health financing
Subramanian S et al. 2019 - Hight cost of care and treatment
- Lack of insurance
- Insurance covered less than expected
- Financial impacts due to breast cancer and treatment
NA - Unavailability of drug
- High cost of cancer treatment
NA - Health financing
- Medication access
M. Toure et al. 2013 - Lack of Financial resources
- Misdiagnosis
- Lack of therapeutic care
- Long wait for biopsy results
NA NA NA - Service delivery
- Health workforce
- Health financing
Okoronkwo IL et al. 2015 - High cost of medical treatment
- Lack of health insurance coverage
NA NA NA - Health financing
Moodley J. et al. 2018 - 4 or more healthcare visits between symptom discovery and a breast cancer diagnosis
- Long wait for surgery
NA NA NA - Service delivery
Bedada T et al. 2018 - Long waiting time in the reception area
- Long waiting time to see a doctor
-Unavailability of an appropriate doctor --Inappropriate diagnosis
- No imaging investigations available
- Professional’s lack of appropriate attention
- Professional’s inability to examine the patient appropriately (patient’s perception)
NA NA NA - Service delivery
- Health workforce
Yang K et al. 2019 - Hospital’s failure to inform patient of biopsy requirements
- Delayed Referral
- Difficulty with navigating the referral system
- Lack of knowledge by provider
- Healthcare professional’s misinterpretation of biopsy results
- Inappropriate treatment
- No referral for further care upon initial presentation
- Misdiagnosis
- Biopsy results delayed
NA NA NA - Service delivery
- Health workforce
Gebremariam A. et al. 2019 - Misdiagnosis
- False-negative laboratory results
- Lack of empathy at first medical consultation
- Visited ≥4 different healthcare facilities before diagnostic confirmation
- Visited a public hospital at the first consultation NA NA - Service delivery
- Health workforce
Agodirin O. et al. 2019 - Delayed Referral (long primary care interval for 69.3% patients)
- Long distance to the specialist clinic
- Visiting more than one provider before diagnosis confirmation
- Misinformation (incorrect advice or directive from first healthcare provider)
- Misdiagnosis and mistreatment (first healthcare provider error)
- Awaiting results
- Conflicting results
- Difficult navigation
- Strike
NA NA NA - Service delivery
- Health workforce
- Governance
Foerster M. et al. 2019 - Expensive healthcare
- Cost of surgery
- Healthcare expenses paid out-of-pocket by the patient
- Equipment (radiotherapy) not available
- Have a healthcare coverage
- availability of free health care -Availability of equipment
NA NA - Health financing
- Medication access and technologies
F. Ntirenganya 2019 -Long waiting for transfer to health facility offering breast cancer surgery
- Long waiting for consultation by a surgeon
- Long waiting for biopsy results
- Long waiting for imaging/staging investigations
NA NA NA - Service delivery
- Health workforce
Agodirin O et al. 2020 - Misdiagnosis by first healthcare provider
- Delayed Referral and long primary care interval
- Inappropriate reassurance by first healthcare provider
- Strike
- Mistrust in conventional medicine
NA NA NA - Service delivery
- Health workforce
Foerster M et al. 2020 - Misdiagnosis
- Inappropriate reassurance
- Visits to 1 to 4 healthcare providers before diagnostic hospital
- High Treatment costs
NA NA NA - Health financing
- Health workforce
Pruitt L et al. 2014 NA NA - Inappropriate medical care (non-physician community healthcare provider)
- Long waiting for test results
- Strikes by hospital staff
- Long waiting for surgery scheduling
- High costs of treatment
- Default histologies and communication
NA - Service delivery
- Health workforce
- Health financing
- Medication access and technologies
Aziato. L. and Clegg-Lamptey 2014 NA NA - Misdiagnosis
- Long waiting for biopsy results
NA - Health workforce
- Service delivery
Johanna E. Maree And J. Mulonda 2015 NA NA - Misdiagnosis
- Mismanagement
NA - Health workforce
Jennifer Moodley et al. 2016 NA NA - Misdiagnosis NA - Health workforce
Kohler Racquel E. et al. 2017 NA NA - Poor provider knowledge and misdiagnosis
- Poor delivery processes
- Medical equipment failure
- Poor access to providers and service
- Long waiting for biopsy results
- Delayed Referral
- Unavailability of medication and provider channels
- Lack of provider communication
NA - Service delivery
- Health workforce
- Medication access
Grosse Frie K et al. 2018 NA NA - Misdiagnosis
- Wrong medication prescription
- Mistrust in healthcare workers
- Unavailability of doctors or drugs
NA - Service delivery
- Health workforce
- Medication access
Sanuade OA et al. 2018 NA NA - High cost of chemotherapy pharmaceutical drugs and other associated costs of breast cancer treatment
- Healthcare workers’ attitude corruption
- Wrong/harmful advice to patients by encouraging them to seek alternative treatment
- Long queues during treatment
- Unavailability of doctors
- Breakdown of hospital machines
- Shortage of medication access
- Workload of the doctors
- Shortage of healthcare workers
- Slow moving queues at the drug dispensary
- Delayed biopsy results from the pathology department
- Long distance between departments involved in breast cancer treatment within the hospital premises
NA - Service delivery
- Health workforce
- Health financing
Ilaboya D et al. 2018 NA NA - Lack of training and lack of breast cancer knowledge among community health workers
- Low prioritization of NCDs
- Lack of cancer policy
- Lack of cancer services at the primary healthcare level
- Geographical inaccessibility of health facilities
NA - Governance/Leadership
- Service delivery
- Health workforce
Martei YM et al. 2018 NA NA - Lack of financial resources
- High cost of chemotherapy drugs
- Limited insurance coverage for chemotherapy and radiation treatment
NA - Health financing
- Medication access
Robai Gakunka et al. 2019 NA NA - Inadequate insurance coverage
- Expensive private insurance
- Discrimination by private insurers
- Misdiagnosis
- Poor communication by caregivers about diagnosis and financial implications causing mistrust between patients and caregivers
- High cost of care
- Short waiting period
- Drug availability
- Good communication by healthcare givers
- Health financing
- Service delivery
- Health workforce
- Medication access
Gebremariam A et al. 2019 NA NA - Physicians misunderstanding of the first symptom
- Inappropriate reassurance that the lump is benign without biopsy
- Long waiting times to receive diagnostic confirmation
- Few diagnostic centres
- Poor provider-patient communication and counselling
- High costs of investigation and treatment
- Delayed referral
- Long waiting period for consultation
NA - Service delivery
- Health workforce
- Health financing
- Medication access and technologies
Getachaw S et al. 2020 NA NA - High treatment costs
- delayed care transitions
- Poor provider knowledge
- Misdiagnosis
- Inappropriate treatment
- Delayed Referral
- Long distance to referral facilities
- Lack of clinical breast examination practice by provider
- Delayed Appointment
- Poor attention by provider
- Inadequate examinations
- Poor communication between healthcare providers and patients
- Several visits to health facilities to get their diagnosis
- High cost of diagnostic services
- Long waiting time for diagnostic tests
- Lack of screening and diagnostic tests in local facilities
- Lack of health education programmes and skilled professionals
NA - Governance/Leadership
- Service delivery
- Health workforce
- Health financing
- Medication access and technologies