Barriers and facilitators to colorectal cancer diagnosis in Zimbabwe: a qualitative study

Incidence of colorectal cancer has steadily increased in Zimbabwe in the last thirty years. Most patients are diagnosed at advanced stages resulting in poor outcomes. The pre-diagnosis experience of the patient and caregiver is poorly understood, yet it may provide insights into interventions needed to ensure more timely diagnosis and improve cancer care. This study aimed to explore the journey to colorectal cancer diagnosis as experienced by the patient and caregiver, specifically focusing on potential barriers and facilitators. Following consent, in-depth interviews were held with thirteen recently diagnosed colorectal cancer patients and thirteen caregivers. These included four patient-caregiver dyads. Participants were consecutively recruited from five participating hospital sites at the time of admission for colorectal surgery. All patients were symptomatic and presented either electively or emergently. Interviews were audio-recorded, transcribed, then translated into English. Transcriptions were inductively coded and summarised into themes and subthemes guided by the Model of Pathways to Treatment framework. The appraisal interval was influenced by symptom normalisation, belief in body self-healing and perceived futility of treatment. Facilitators to consultation included alarming symptoms, persistence or worsening of symptoms and the influence of social networks. In the help-seeking interval, challenges to diagnosis included lack of finances and logistical means to attend appointments – all amplified when the healthcare facility was distant. Family was a key facilitator when they could provide financial, and other support, including the designation of a caregiver who acted as a chaperone during all health-related visits. In the diagnostic interval, significant barriers were the centralization of services, high costs, inefficient consultation scheduling and misdiagnoses. A positive experience was reported when there was good patient-doctor rapport, healthcare workers were knowledgeable, and clear referral prompts and pathways were provided. Social welfare department support proved vital to the successful diagnosis of several participants. This study highlights multiple barriers to colorectal cancer diagnosis that need to be addressed from a public health education and health system policy perspective. We should leverage on the various facilitators to diagnosis, particularly the key role that caregivers play in the support of patients to access care.