冈比亚女性乳腺癌患者获得医疗服务的障碍与促进因素特征分析

Background: The Gambia, the smallest country within mainland Africa, is estimated to have one of the lowest cancer survival rates of countries in Africa, Asia, and Central America. Although poor access to healthcare contributes to low breast cancer survival rates in The Gambia, little is known about patient experiences across multiple healthcare access domains. The purpose of this study was to characterize healthcare access barriers and facilitators to breast cancer care. Methods: Twenty-three breast cancer patients from the Edward Francis Small Teaching Hospital (EFSTH; largest referral center in the country) in Banjul, The Gambia participated in semi-structured interviews from June-December 2023. Interviews were conducted in Wolof, Mandinka and/or English as appropriate. Topics included patient experiences and pathways to diagnosis, prior knowledge and beliefs about breast cancer, barriers to accessing care, and cultural factors impacting the treatment journey. Analysis coupling an inductive approach with an initial deductive approach following Penchansky and Thomas's (1981) theoretical framework of healthcare access resulted in a final set of codes. Results: Of the 21 participants with available age data, the mean (SD) age was 44 (10) years. Most participants had little to no knowledge of breast cancer prior to their diagnosis. The time from symptom onset to diagnosis ranged widely from a few weeks to months or years. Seven participants (30%) reported using traditional medicine prior to visiting a healthcare professional. Affordability of diagnostic procedures and treatments was the most frequently mentioned barrier (91% of participants), followed by availability of services (e.g., providers, working equipment, facilities' capacities to perform procedures, medications, etc.; 83%), accessibility (distance and travel) of providers (74%), accommodation (health system organization) in relation to the preferences of the patients (43%), and acceptability (quality of patient-provider interaction; 9%). Family, peers, and faith were important sources of support and comfort during the cancer journey. Conclusions: Our results highlight major barriers to healthcare access among breast cancer patients in The Gambia, leading to delays in diagnosis and treatment. Multi-level initiatives to address these barriers will be crucial to reducing the breast cancer burden within the country.