Expanding Geographical Access to Cancer Care in Botswana: Current Status and Future Prospects.

PURPOSE: The growing cancer burden in Botswana has been linked to aging, lifestyle factors, and high HIV infection prevalence. The government has designated four geographically distributed hospitals as public oncology centers (POCs). A needs assessment was undertaken to ascertain the characteristics of cancer care at these centers. METHODS: A multisite cross-sectional survey study of cancer care was conducted with oncology staff at Princess Marina Hospital (PMH), Nyangabgwe Referral Hospital (NRH), Sekgoma Memorial Hospital (SMH), and Letsholathebe II Memorial Hospital (LMH) from February to April 2021. At each POC, a focal person (experienced nurse working in oncology) identified relevant oncology staff and confirmed service availability. RESULTS: Only PMH and NRH had a broad array of diagnostic, surgical, and treatment services. In addition, PMH was the only center with a a dedicated inpatient oncology service, a multidisciplinary committee to review patients, and a palliative care team. To support the only national cancer screening program, for cervical cancer, all POCs offered Pap tests. Mammography, available at PMH and NRH, was used solely for diagnosis. Patients from POCs requiring radiation therapy were referred to Gaborone Private Hospital at government expense. For perceived service availability, 51 staff, mainly oncologists, physicians, and nurses, were surveyed (66% based at PMH). Perceptions of services revealed a few concerns, for example, numerous staff considered hysterectomies for cervical cancer available when they were only performed at PMH. CONCLUSION: Despite Botswana's efforts to increase the proximity of cancer services to patients, there are marked gaps, particularly at the two district-level POCs, SMH and LMH. In the future, SMH and LMH could provide selected services for specific prevalent cancers on-site, as well as follow-up and palliative care.

The health mentors program: three years experience with longitudinal, patient-centered interprofessional education.

Increased emphasis on team care has accelerated interprofessional education (IPE) of health professionals. The health mentors program (HMP) is a required, longitudinal, interprofessional curriculum for all matriculating students from medicine, nursing, occupational therapy, physical therapy, pharmacy, and couple and family therapy. Volunteer lay health mentors serve as educators. Student teams complete four modules over 2 years. A mixed-methods approach has been employed since program inception, evaluating 2911 students enrolled in HMP from 2007 to 2013. Program impact on 577 students enrolled from 2009-2011 is reported. Two interprofessional scales were employed to measure attitudes toward IPE and attitudes toward interprofessional practice. Focus groups and reflection papers provide qualitative data. Students enter professional training with very positive attitudes toward IPE, which are maintained over 2 years. Students demonstrated significantly improved attitudes toward team care, which were not different across programs. Qualitative data suggested limited tolerance for logistic challenges posed by IPE, but strongly support that students achieved the major program goals of understanding the roles of colleagues and understanding the perspective of patients. Ongoing longitudinal evaluation will further elucidate the impact on future practice and patient outcomes.

Dissecting first-year students' perceptions of health profession groups: potential barriers to interprofessional education.

BACKGROUND: Previous research has shown that health profession students enter interprofessional education (IPE) programs with negative perceptions of health disciplines other than their own, which could serve as possible barriers to engagement with interprofessional principles. Yet, past studies have not fully dissected these perceptions, nor have they examined how these perceptions may contrast with how students view their own future profession. METHODS/FINDINGS: A total of 638 students from six different health profession training programs completed surveys assessing their perceptions/stereotypes of their own and other health professions. ANOVA and MANCOVA analyses showed a high degree of variability in how each profession is perceived by the students, but that the students, regardless of discipline (except medical students), rated their own profession the highest on almost every attribute listed. CONCLUSIONS: The data provide evidence for the tenets of Social Identity Theory raised in the relevant literature. The authors also suggest that the lack of adequately formulated "professional-in-training" identity, as well as the formidability of anticipatory socialization, help to foster and perpetuate these stereotypes and that IPE programs have the potential to exacerbate these negative perceptions.

Jefferson interprofessional clinical rounding project: an innovative approach to patient care.

BACKGROUND: Bedside rounding is an historical clinical model that brings together care providers and the patient to discuss the plan of care. Interprofessional clinical rounding is an approach that uses this historical model to involve multiple health professions. This study was conducted to determine if a model of interprofessional clinical rounding could be implemented successfully in an acute care setting. METHODS: Teams consisting of medical, nursing, and pharmacy students were assigned to work with the attending physician (AP) in the colorectal surgery service. Prior to the rounding experience, students met to review and discuss patients' data from their discipline-specific perspective and then made a presentation of the case to the AP, who used these presentations as an educational opportunity, asking probing questions. A structured observation form was used to assess the team members' interaction during this process, and a debriefing was held at the conclusion of each experience. FINDINGS: Results of the observations suggested that most students were very engaged in the process, while summaries of the debriefing revealed a high level of satisfaction among participants. All groups suggested that they had a better understanding of the roles of other professions as a result of the increased communication and claimed that the process resulted in a more patient-centered approach. They also claimed that the additional information provided through the team approach resulted in a more integrated plan of care because input is provided from these different perspectives. CONCLUSION: Interprofessional bedside rounding can be implemented successfully, resulting in a more effective experience for health professions students.

Effect of the health mentors program on student attitudes toward team care.

Based on a growing body of literature documenting improved cost and quality outcomes related to good team care, interprofessional education (IPE) has been widely endorsed as critical to preparing the future healthcare workforce. This study evaluated the effect of a longitudinal team-based 2-year IPE curriculum on attitudes toward health care teams. Analyses included comparison of baseline measures to the end of the 2-year curriculum of each of the six participating disciplines (medicine, nursing, occupational therapy, pharmacy, physical therapy, and couple and family therapy). Differences between the disciplines were also analyzed. A significant improvement on a 14-item quality of care and teamwork of health professionals subscale of the Attitudes Toward Health Care Teams scale was found. Students surveyed in each of the six disciplines demonstrated significant improvements in attitudes toward quality of care and teamwork from the baseline measure at the beginning of the IPE program to the end of the 2-year program. There were no significant differences noted between disciplines. Assessment of attitudes toward health care teams assisted in evaluation and ongoing quality improvement of the IPE program and could potentially be used in other interprofessional programs that focus on health care teamwork. Next steps include longitudinal assessment of students throughout their programs and into practice to explore the sustainability of attitudes and behaviors, as well as impact on patient outcomes.