Cancer patients' and health care professionals' perceptions and experiences of cancer treatment and care in South Africa

PhD (Psychology), North-West University, Potchefstroom Campus, 2014Cancer is a potentially life-threatening disease, which affects millions of people worldwide. It is multifaceted in nature and can lead to impairment in a person's physical, social and emotional functioning (Beatty, Oxlad, Koczwara, & Wade, 2008). Multidimensional treatment, with highly specialised professionals, equipment and services is thus needed for the effective treatment thereof (Mathews, West, & Buehler, 2009). Patients treated within the private and public healthcare sectors of South Africa have vastly differing treatment experiences. Only about 20% of the South African population has access to and can afford treatment within the private healthcare sector (Somdyala, Bradshaw, Gelderblom, & Parkin, 2010). While private sector patients have access to information, social workers and support groups, those in the public sector face life-threatening waiting times and a lack of empathy by public sector staff, weighed down by patient numbers and a lack of resources (Pillay 2002; Bateman, 2011). A study previously conducted by the researchers highlighted cancer patients' perceptions and experiences of treatment as being one of the most prominent themes influencing patients' overall cancer experience (Venter, Venter, Botha, & Strydom, 2008). This, coupled with the fact that the majority of research studies previously conducted in South Africa generally focused on the biomedical aspects of cancer (Albrecht, 2009), make exploring patients and healthcare professionals' perceptions and experiences of cancer treatment in a South African context potentially valuable. The thesis consists of three sub-studies reported in three manuscripts. The aim of the first article was to provide a narrative literature review exploring cancer survivorship and management in the South African context by scrutinising research previously conducted on cancer treatment. The aim of the second and the third article was to explore patients and healthcare professionals' perceptions and experiences of cancer treatment in the private and public healthcare sectors in the Eastern Cape, South Africa. A 100 participants were purposively sampled from a government-funded hospital (n = 30 patients; n = 22 healthcare professionals) and a private treatment facility (n = 30 patients; 18 healthcare professionals). Data was collected by making use of both qualitative (self-report questionnaire consisting of open-ended questions; interviews) and quantitative (Needs Evaluation Questionnaire) measures. A qualitative content and statistical analysis was conducted. Findings indicate that despite the expressed need for treatment to move towards a more biopsychosocial approach, the majority of the healthcare professionals in the current study are still primarily following a biomedical approach. Findings also indicate that the majority of the difficulties and frustrations experienced could be seen as being contextual problems and were not necessarily related to cancer treatment per se. Poor availability of resources and the South African population's diverse characteristics were responsible for the majority of the difficulties reported. Differing cultural beliefs, language barriers, illiteracy and unemployment were all seen as negatively influencing the treatment process. This is consistent with Serin et al. (2004), who reported that there is a significant relationship between the systemic nature of medical issues and the social, material and psychological difficulties cancer patients' experience. The systemic nature of healthcare needs highlighted in the current study emphasises the necessity for cancer treatment in South Africa to employ a more biopsychosocial approach. True collaboration between healthcare professionals working towards a common goal should thus be considered as being the ideal. Considering the socioeconomic divide and resource discrepancy between the private and public healthcare sectors in South Africa, credence must be given to the allocation of resources in the public sector. If this incongruity is to be addressed, there would have to be cooperation at government level. Assistance with regard to the allocation of funds, as well as the meticulous monitoring of the distribution thereof, is needed. Funding should be used to increase human and technical resources, as well as for staff development. Equitable care for all cancer patients, regardless of their socioeconomic status, is the ideal. The following recommendations on how to improve overall cancer care, in both sectors, can also be made: existing treatment sites need to be updated and additional sites developed; continuous research needs to be conducted; funds need to be allocated towards the development of effective transport and translation services; cultural diversity should be taken into account when developing awareness campaigns and treatment plans; healthcare professionals need to adopt a holistic approach during which attention is given to communication, establishing rapport and patient participation; and lastly healthcare professionals should also be encouraged to pay attention to their own healthcare needs as well.Doctora