National Healthcare Provider Assessment of Guideline Adherence and Multi-disciplinary Breast Cancer Care in Nigeria: A Call for Action
Authors: Romanoff Anya , Olasehinde Olalekan , Lynch Kathleen , Folorunso Sharif , Omoyiola Oluwatosin , Omolade Betiku , Omisore Adeleye , Okereke Chukwuma Eze , Agodirin Olayide , Muhammad Abubakar Bala , Ali Nuhu , Irowa O. , Nweke N. A. Sunday , Nwokwu Uchechukwu Emmanuel , Kalvin Hannah , Kahn Rivka , Fitzgerald Grace , Vreeman Rachel , Anderson Benjamin O. , Ostroff Jamie , Kingham T. Peter , Alatise Olusegun Isaac 
Published: July 2024

PURPOSE The Nigerian Federal Ministry of Health (FMOH) endorses National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for sub-Saharan Africa (SSA) for breast cancer (BC), which were developed with the African Cancer Coalition and resource adapted for SSA. The FMOH advocates for multi-disciplinary tumor boards. This research aimed to better understand guideline awareness, adherence among specialties and multi-disciplinary care as a basis for an implementation plan. METHODS Guided by the Consolidated Framework for Implementation Research (CFIR), a multi-national, multi-disciplinary team developed a healthcare provider (HCP) questionnaire to evaluate guideline-adherent BC care practices. HCPs in Nigeria were recruited electronically through society distribution lists and snowball sampling from November 2023–January 2024. Results were analyzed using descriptive statistics and univariate logistic regression. RESULTS Participants (n=277) included: surgeons (n=124, 45%), radiologists (n=59, 21%), clinical oncologists (n=49, 18%), and pathologists (n=45, 16%). HCPs had a median 7(IQR 3-12) years in practice and devoted an estimated 30% (IQR20-50) of their practice to breast healthcare. 79% (n=217/274) practiced in a teaching hospital. Only 38% (n=103/273) reported structured multi-disciplinary discussion at their institution. 92% (n=253/274) of HCPs believe BC guidelines contribute to better patient outcomes and 51% (n=100/195) routinely consult guidelines in practice. However, 69% (191/277) reported insufficient resources to routinely provide guideline-adherent care and 46% (122/266) regularly adjust clinical recommendations based on patients’ ability to follow them. NCCN guidelines were most cited, but only 34% (93/277) were aware of FMOH-endorsed Harmonized Guidelines. Clinical oncologists were 5-times more likely than surgeons (OR-0.20, 95% CI: 0.09, 0.42), and 20- and 50-times more likely than pathologists (OR-0.05, 95% CI: 0.02, 0.14) or radiologists (OR-0.02, 95% CI: 0.01, 0.06), respectively, to consult guidelines regularly. Completing a cancer-related fellowship, devoting more time to breast healthcare, and receiving additional BC training were associated with consulting guidelines. 70% (195/277) of HCPs identified a need for additional education/training in BC care. HCPs who regularly engage in multi-disciplinary discussion were more likely to consult guidelines (OR-2.60, p=0.030). To ensure delivery of guideline-adherent care, 83% (230/277) reported needing greater access to multi-disciplinary discussion. CONCLUSION A major gap exists between FMOH recommendations and current practices in BC guideline utilization and multi-disciplinary care. Structured multi-disciplinary discussion can provide a forum for promoting awareness of resource-compatible Harmonized Guidelines, sharing knowledge across provider-types, and developing resource-appropriate patient care plans.