• 2022-09
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  • br High cost of treatment


    High cost of treatment was unanimously mentioned by the clin-icians as a significant challenge for the patients they see. Although the National Health Insurance Scheme was supposed to cover all women cancers, the scheme did not realistically cover treatment for breast cancer; hence, patients pay out of pocket for everything related to breast cancer. This pose financial stress which led patients who have no solid financial support to give up on modern medicine.
    “Treatment for breast cancer is very expensive, and the patients have to pay out of pocket for everything because the NHIS is practically not working as claimed. Hence, the cost of medical care, travel cost and cost of living causes the patients to avoid hospital” (Akwasi).
    Clinicians further noted that lack of confidence in the healthcare system led to delay in using it. Misdiagnosis and mismanagement of breast symptom by health practitioners at the first place of care, lack of meaningful diagnostic pathways, lack of skills amongst medical prac-titioners, a limited oncology workforce and negative attitude of some health professionals led patients to lose trust in the modern medicine option. This increases patients’ preference for traditional and spiritual sources of treatment. To illustrate, Adizah shared an experience of one of her patients who presented with metastatic disease in a very bad state. She narrated:
    “The patient and her family told me their reason for the delay. The woman reported to a district hospital within 2 days of symptom dis-covery, but she was told by a clinician that there was nothing wrong with the breast. She was not satisfied because she could feel the lump, hence, she moved to a regional hospital in the national capital city for further consultations, but she was again told that the breast was ok and she was managed on pain killers and RIPA Lysis Buffer for 5 months. She then sought care at a private oncology center when additional symptoms of pain and lymphadenopathy occurred, yet, she was told that her breast was ok and managed on painkillers and antibiotics for close to one year. The breast ulcerated but she stopped the private consultation due to high cost of care and worsening symptoms. Then a family friend directed them to a herbalist where she spent an additional 3 months before reporting to our facility. Even, as a teaching hospital, she spent over 4 months during medical evaluation to get a confirmed pathology report. Most of her la-boratory investigations such as mammography was done at a private facility because, our mammography machine broke down some years back and has not been fixed. Most of our patients go through similar situations”
    All the clinicians recognized an urgent need for an intervention to make women aware of breast cancer, promote prevention and early detection, and enhance the competencies of health professionals in breast cancer diagnosis and management. Further, a model of care for the intervention was proposed. Four sub-themes emerged: integration of awareness and screening initiatives into palliative care services, de-velopment of a model of care, extension of an early detection program into the community and lastly, advocacy among health professionals.  International Journal of Africa Nursing Sciences 11 (2019) 100162
    2.9. Sub-theme # 1: integration of awareness and screening initiatives into palliative care services
    All the clinicians acknowledged the need to initiate awareness and screening services for asymptomatic women through palliative care to promote early detection of the disease. To the clinicians, every disease prevention program will work best if it is integrated into palliative care due to the opportunity of meeting families and the entire community through one patient. For instance, Pat viewed palliative care as a big tool for changing knowledge, attitude and cultural narratives around breast cancer. She shared: