Table 2 Main factors (barriers and facilitators) identified across studies
Author | Main finding | WHO building blocks addressed | |||
|---|---|---|---|---|---|
Quantitative research Barriers Facilitators | Qualitative research Barriers Facilitators | Â | |||
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 | Â | - 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 |