Barriers to Evidence Based Colorectal Cancer Care in Ukraine
Pamela Lu MD1, Galyna Shabat MD PhD2, Volodymyr I. Pylypchuk MD PhD2, Volodymyr Galyuk MD PhD2, Solomiia Semeniv MD3, Adam C. Fields MD1, Joel E. Goldberg MD1, Jennifer L. Irani MD1, Ronald Bleday MD1, Nelya Melnitchouk MD MSc1 1 Brigham and Women's Hospital, Department of Surgery, Boston, MA, 2 Ivano-Frankivsk Regional Hospital, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine 3 National Children Specialized Hospital "Ohmatdyt", Kyiv, Ukraine
Background:
The incidence of colorectal cancer is increasing in low-to middle- income countries with significant disparities in survival. One year mortality rate for newly diagnosed colorectal cancers in Ukraine is 35% and many patients do not receive cancer specific care. We examined the attitudes towards evidence based guidelines and colorectal cancer care in surgeons practicing in Ukraine to better understand the barriers present.
Methods:
A 26 question multiple choice survey instrument was developed to assess surgeon attitudes towards evidence based treatment guidelines and current practices for colorectal cancer. This anonymous survey was administered to attendees at the Regional Surgical Conference in Ivano-Frankivsk, Ukraine.
Results:
105 surgeons participated. 93.3% of respondents were male, and 6.7% female. Most surgeons fell in the 37-55 year-old age category, and over 80% had practiced for more than 10 years. While only 55.2% of surgeons provide primary treatment to patients with colorectal cancer, 90.5% treated patients with subsequent complications, including perforation, bleeding, and obstruction. 76.2% reported using standard guidelines in daily practice. The most frequently used guidelines were from the Ministry of Health of Ukraine (71.4%). In identifying barriers to following treatment guidelines, 28.6% cited lack of English proficiency, and 24.8% cited inadequate hospital resources. For factors that would help surgeons provide patients with guideline adherent care, 62.9% cited additional knowledge, and 74.3% cited additional financial resources.
Conclusion:
In Ukraine, unique barriers exist that prevent patients from receiving treatment according to established guidelines. To improve survival in low income countries, targeted interventions should be pursued.
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