Cluster randomised trial of an education and navigation support intervention in primary care facilities in low and middle-income countries to reduce delays in cancer diagnosis
Reducing the time interval between presentation to the formal health sector with a symptom and receiving treatment for patients presenting with symptoms consistent with cancer
Education In-person education sessions will be delivered to different cadres of clinical staff face-to-face, followed by an online refresher/consolidation course. The syllabus is based on need and existing evidence and guidelines for referral. The syllabus also includes management and leadership training for clinic strengthening. The syllabus has been developed with support from local and international experts (in clinical work and in education). Clinic strengthening Patients who are referred do not often remember all that they are told and may be confused about where precisely they should attend and when. We will therefore implement a system to reinforce and extend the information that is provided verbally. We will co-design and implement a leaflet to provide people with more information and links to other sources of relevant information. This leaflet will include the telephone number of a peer navigator they can contact for further support. Text messages on mobile phones will reinforce the importance of attending and provide patients with information on where they can get help and support to facilitate navigation to the appropriate specialist or diagnostic service. Patients will receive telephone support from the referring clinic. We shall mentor clinics so that they have a consistent process to guide the patient through the clinic and onward to the appropriate hospital for their needs. If necessary, further support will be provided from peer navigators recruited and trained for the purpose. Peer navigation Peer navigation services will be offered to referred patients in our selected health facilities to help patients, especially poor people with low health literacy, to take up their referrals. A peer navigator is someone who is drawn from civil society, who is trained and will support a patient navigate the healthcare system following their referral. Each of the three trial arms will receive all three components of the intervention at different time points o
Healthcare facilities 1. Within each of the defined study areas facilities offering general outpatient primary care consultations for undifferentiated patients will be eligible for participation. These facilities include both small practices to large hospital polyclinics. Clinicians 1. All clinical staff who see patients for a primary care consultation will be eligible to participate in the study. This includes all relevant cadres of clinical staff: doctors, nurses, clinical officers, community health workers, community health assistants, and community health extension workers. Patients 2. Patients who are over the age of 18 and referred to secondary / specialist care with symptoms consistent with cancer.
Healthcare facilities 1. ‘Single-handed’ facilities providing fewer than ten clinical sessions per week, where a “session” is defined as a half-day by one clinical staff member. 2. Facilities that do not receive “walk-in” patients. 3. Facilities that do not receive all patients represented by the standardized patient cases, for example, male- or female-only facilities. 4. Specialist clinics not offering diagnosis and treatment of undifferentiated patients. Clinicians 1. Does not see patients in a clinical setting. Patients 1. Pregnant 2. Children (under age 18) 3. Emergency referrals 4. Previous diagnosis of cancer or presenting for routine follow up of existing cancer diagnosis. 5. Patients not fulfilling criteria of symptoms consistent with cancer.