Growing awareness and strengthening patient navigation for metastatic breast cancer patients in Ghana

Context

In Ghana, breast cancer is the most common cancer among women, and accounts for over 30% of new cancer cases.[1] According a study conducted by Komfo Anokye Teaching Hospital (KATH), 85% of breast cancer patients presented with advanced disease (stages III and IV) between 2004-2009.[2] A number of factors contributing to the delayed presentation and diagnosis are well-documented in the literature, including lack of information and awareness about breast cancer, poverty, low health literacy, lack of access of healthcare, and challenges in navigating the health system. To address these issues and improve the quality of end-of-life care among metastatic breast cancer (MBC) patients and reduce the delays in accessing treatment, KATH has developed and implemented a structured patient network and navigation system in their hospital.

KATH is the second-largest hospital in Ghana which mission is to provide quality healthcare services to its patients. The hospital currently has a workforce of approximately 4,000 and is located in Kumasi, the capital of the Ashanti region.

Project description

KATH was awarded a SPARC MBC Challenge grant in 2017 to support MBC patients in Kumasi region, and to raise awareness on breast cancer. The main project objectives were:

• To create a culturally appropriate social media networking platform and navigation programme for patients with advanced (stages III and IV) breast cancer.
• To train community health nurses and community volunteers as patient navigators.
• To offer psychosocial support to patients with advanced breast cancer, and their families, in particular supporting them in the management of symptoms
• To assist women with suspected breast cancer to navigate the complex health care system as well as to communicate effectively with healthcare professionals and other agencies involved.
• To create awareness on breast cancer with emphasis on breast health checks and early detection

KATH identified, recruited and trained patient navigators, from amongst healthcare workers and community volunteers, including breast cancer survivors. The training included topics such as treatment, referrals, survivorship, misconceptions about MBC, interpersonal communication, mixed communication styles (social media, home visits and community conversations) and patient navigation. After the training, KATH followed-up with the navigators via periodic supervision visits to ensure proficiency in the competencies acquired.

KATH also set-up a social media networking platform for patients to share experiences and discuss concerns. Furthermore, they launched a community-based awareness campaign that included talks to community groups, house-to-house visits and a media campaign. 

Impact

KATH implemented a structured patient network in the Kumasi region to reduce the delays in accessing care. They successfully established and implemented a navigation programme in five sub-regions of the Kumasi Metropolis. In total, 18 patient navigators were trained, including 15 community volunteers and three oncology nurses. A social media platform to connect patients, navigators, survivors and experts in breast cancer was created.

“I was given a death sentence and my will to survive was so little. I always thought that cancer was a “sad” disease but seeing the positivity expressed by fellow patients showed me that there is still hope in spite of it all. Joining the navigation platform really changed my outlook on cancer especially at times when I feel very depressed. I would strongly advise persons out there that you should not fear cancer. Thanks to the navigation team.” 
A MBC patient enrolled in the navigation programme

Through the navigation programme, a total of 600 women have received direct support, either psychosocial, discussions regarding the management of their symptoms or advice on how to navigate the health system. In the first year of the project 1,015 home visits were made. KATH’s awareness campaign is estimated to have reached 20,000 people across Kumasi.

KATH has worked in close collaboration with the Metropolitan Health Directory and community leaders since the beginning of the project. Notably, Lady Julia, the wife of the King of Ashanti, has promoted this project and gave it important local visibility.

In the future, KATH plans to publish the results of the project in a scientific journal as well as scale-up the cancer navigation services across the Ashanti region, with the hopes of potentially developing it into a national programme. 

More

Organisation’s website: Komfo Anokye Teaching Hospital’s website

Article on Ghana Live: Lady Julia Leads Breast Cancer Campaign

Scientific article: Breast Cancer in Ghana: Demonstrating the Need for Population-Based Cancer Registries in Low- and Middle-Income Countries, JCO Global Oncology, December 2017

References