Experiences of patients with cancer regarding decentralization of oncology services at a selected tertiary hospital in the Eastern Cape

Background: Cancer burden is a global public health concern. It is associated with high morbidities and mortalities worldwide. Over the past decade, there has been a constant increase in the incidence of cancer cases affecting mostly low-income countries and middle- income countries. South Africa as a middle-income country is also affected by this cancer rise. The limited access to oncology services contributed to the late presentation and late diagnosis. In the Eastern Cape, oncology services were previously offered in Port Elizabeth and East London only. Oncology unit was recently opened in Mthatha to decentralize oncology services in the province. The purpose of the study was to explore the experiences of patients with cancer regarding decentralization of oncology services at a public tertiary hospital in the Eastern Cape province of South Africa. Objectives were to describe experiences of patients with cancer regarding decentralization of oncology services at a public tertiary hospital in the Eastern Cape, and to describe the quality of oncology services provided by a public tertiary hospital in the Eastern Cape. Methods: a qualitative research approach with a descriptive, explorative, and contextual design was undertaken in this study, to get the perspective of the oncology healthcare service recipients on the decentralization of oncology services at a public tertiary hospital. An interview guide was used to get experiences of the cancer patients attending oncology clinic. Interviews were conducted to 19 participants on a one-to-one basis. With ethical consideration, all COVID-19 protocols were observed. All interviews were transcribed carefully against their audio-recordings. Field notes were also taken by the researcher on what was heard, observed, thought and experienced during the interview process. The concept of trustworthiness was used to ensure rigour throughout this study. Data was analysed by means of thematic analysis. Data was organized into themes using the Tesch’s approach to open coding in qualitative research. Results: seven themes emerged: 1) experience related to a high level of satisfaction with services provided and desired expectations, 2) waiting time, 3) availability of human and material resources, 4) attitude of health care workers, 5) appropriate treatment and care, 6) access to services, and 7) need for improved infrastructural facilities. Many patients had positive experiences about decentralization of oncology services in the province. Most patients were happy about travelling short distances, a smaller number of days, using less money and the time it takes to see a doctor. They also expressed their satisfaction on the quality of oncology services rendered in the unit. The waiting times were acceptable, medicines available and staff had positive attitudes towards the patients. The study revealed that, there were complaints about infrastructure, poor hospital record keeping, and lack of resources. The themes which emanated from the recordings of the study showed that patients with cancer, attending oncology clinic at a public tertiary hospital had positive experiences in this decentralized oncology unit. The services rendered at the facility were of acceptable quality. Staff had positive attitude towards their patients. All patients were seen by the doctors within acceptable waiting time, and they all got their prescribed medication. Access to services was much improved in terms of distance, number of days travelled by patients to access the service and time taken to see the doctor for appointments. Conclusion: The hospital must improve its infrastructure, record keeping, security, and expand the services. Put more focus on cancer awareness programs.Thesis (MPA) -- Faculty of Health Sciences, 202