Nineteen clinically stable cancer patients of African ancestry participated in the study. The sample was an aging population from 35 years to 85 years old. This study found that majority of participants were older than 50 years. It was only one participant who was between the ages of 41 years and 50 years; one participant between the ages of 35 years and 40 years whilst another participant between the age of 35 years. Researchers agree that cancer patients are increasingly getting older (Bluethmann et al., 2016; Miller et al., 2016). As you get older you are more likely to get cancer. Old age is the biggest risk factor for cancer. Researchers are not sure what is the reason for this. It could be the fact that elders have been exposed for longer to cancer-causing agents like sunlight, cigarette smoke, and other chemicals (Pilleron, Sarfati, Janssen-Heijnen, Vignat, Ferlay, Bray & Soerjomataram, 2019).
Most of the participants were females. Out of the 19 participants, 18 were female and only one was male. According to the Eastern Cape Cancer Registry report of 2003 to 2007, about 60% of confirmed cancer patients in the province were females. The South African National Cancer Registry report of 2018 shows that 52% of cancer patients in the country are females. Although this study could not delineate the kinds of cancers, researchers concur with these results to say those female cancers in the country are on the rise, especially breast cancer and cervical cancer (Mbeje et al., 2021).
Themes
Theme 1: Experiences related to satisfaction with services provided and desired expectations.
All the participants had positive experiences regarding the services provided to them and what they expected from the oncology unit. These results concur with other studies showing that decentralization of oncology services leads to positive experiences and improved patient outcomes (Arenas et al., 2015; Wilkens et al., 2016). The decentralization of oncology services to this public tertiary hospital showed improved patient care and reduced workload to its referral tertiary hospital. This is confirmed by participants that they are always attended to by the healthcare workers during their appointments and the services they get from the facility are satisfactory. There is also a decrease in the number of patients that are referred to East London. In developed countries, the decentralization of cancer services led to improved patient outcomes, where clinicians had fewer patients to attend to, thus increasing provider-patient interaction and reducing workload at higher facilities (Arenas, Gomez, Sabater, Rovirosa, Biete, & Colomer, 2015; Wilkens, Thulesius, Schmidt, & Carlsson, 2016)
Theme 2: Waiting time.
According to the National Core Standards 2011, the average patient waiting time for Specialized Hospitals is one to two hours, for Public Health Centres is two to three hours, for District Hospitals is two to three hours, for Regional Hospitals is three to four hours, and for Tertiary, Hospitals is three to four hours.
In this study, most participants reported that a doctor saw them within a brief period during their last two visits. Nine participants indicated that they waited for less than 30 minutes, eight for 30 minutes to 1 hour, and only a few waited for more than 1 hour. According to National Core Standards acceptable waiting time is up to 3 hours for a tertiary hospital. Most patients were seen by the clinicians within an hour which is the acceptable waiting time. Therefore, decentralisation of oncology services in this public tertiary hospital did not compromise the quality of services. Oncology services offered in this decentralised unit meet the criteria for National Core Standards.
Theme 3: Availability of human and material resources.
All the participants reported that they had never visited the oncology unit and return home without being seen by a clinician. The findings of the study are in line with the purpose and rationale of decentralization where smaller organizations are integrally accountable and more responsive than larger organizations. Other study conducted in Finland show similar results. The study showed that decentralization of oncology services improved patient care, access to treatment and had positive outcomes, especially where clients found it difficult to travel to centralized centers (Khatri, Peterson, Kyriazokos, 2011). In a healthcare setting, the possibility of establishing more locally operated, locally responsible institutions, holds out great desirability compared to centralized services (Azfar et al., 2018). In this decentralized oncology unit, collected data showed that all patients were seen by clinicians every day they come for treatment. This has a positive impact on the services rendered by the unit. When patients come to hospital for treatment, they always expect to be seen by a doctor. When that does not happen due to overcrowding or shortage of staff, the quality of the service rendered is negatively affected. The health system in South Africa has a crisis of staff shortage (Malakoane, Heunis, & Kruger, 2020). However, it was also reported that challenges of a deficiency of radiographers in hospitals, ageing equipment and a burden of high cancer patients (Stefan, 2015) were a negative reflection on the facility. In addition, researchers agree that the immense oncologist crisis, with a liberal decrease in clinical and radiation oncologists in the academic and state sector are not rare observations (Balogun, Rodin, Ngwa, Grover, & Longo 2017. What the recommendation for this challenge?
Theme 4: Attitude of health care workers.
Almost all participants described the nurses and doctors as caring and loving people. They experienced positive attitudes from the clinicians during patients' care and personally. The participants benefited from these positive attitudes and were very happy. Other studies concur with the findings of this study. These studies found that staff attitude and knowledge are major factors that affect successful recovery of chronically and terminally ill patients (Kassa et al., 2014; Parveen et al., 2020).
Theme 5: Appropriate treatment and care.
All the participants were satisfied with the treatment and care they were receiving at the facility. They were happy because the treatment and care they received was what is needed for cancer patients. Some of them noted that they had never left the facility stressed, and they had no complaints. Similar effects of health system decentralization were observed in a study conducted in Honduras. The study focused on making social services work better for the poor. There was an increase in production of preventative women health services. The was also increase in of consultations of patients with clinicians, and improvement in healthcare service delivery (Zarychta, 2020). Fifteen participants noted that they were receiving the appropriate treatment and care as evidenced by their improved health status. Contrary to the report released by South African Human Rights Commission on how the Department of Health had failed its cancer patients, the oncology unit at this public tertiary hospital managed to provide appropriate treatment and care to its patients. The report also said that not only had the number of specialist doctors declined but hospitals had a shortage of chemotherapy drugs (Kollapen, Carnelly, Jaichand, Lawrence, Oguttu, Sello, & Siwendu, 2017). The shortage of specialist doctors and chemotherapy drugs harm service delivery. The quality of services is compromised by the shortage of human and material resources.
Theme 6: Access to services.
All the participants appreciated having this facility close to home and receiving cancer treatment. According to most of the participants, they can now access cancer care personnel and services with minimal delays. The data collected from the participants showed that bringing the oncology services closer to people helped them ease the burden of travelling the long distances for treatment. Decentralization of oncology services close to reach areas improved patient care and positive outcomes, and access to treatment, especially where clients found it difficult to travel to centralized centers (Khatri, Peterson, Kyriazokos, & Prasad, 2011). Decentralization also led to increase in access by removing the impediment of travelling a long distance to obtain cancer care services (Arenas et al., 2016). The study findings are in line with Batho-Pele principles (1997) as far as access to services is concerned. It states that all South African citizens should have access to services to which they are entitled to.
Theme 7: Need for improved infrastructural facilities.
These participants were clear about the need for improved infrastructural facilities. They complained about the overcrowding at the centre, expressing fears of contracting Covid-19. They also raised insecurity, lack of warm water for bathing, lost hospital files, and delayed delivery of laboratory results. The findings in the study are in line with other studies conducted by other researchers such as Saad (2015), and Jenkins et al., (2019). According to Saad (2015), the major challenge in screening, diagnosis and treatment of cancer is lack of proper infrastructure and resources. Lack of infrastructure is a common challenge in developing countries (Saad, 2015). When it comes to radiotherapy equipment, the issue is exponentially more complicated when it comes to equipment acquisition, operation, and maintenance (Saad, 2015). A study done in Vietnam among healthcare professionals revealed that oncology service provision was hindered by a lack of resources both to skilled healthcare providers and health infrastructure for the management of cancer. (Jenkins, Ngan, Ngoc, Phuong, Lohfeld, Donnelly, Van Minh, & Murray, 2019). The participants also complained about lost hospital files. According to Koelble & Siddle (2014), the available medical records system is still an old-fashioned hard copy file system, housed in an archive room that no longer fits the huge number of files. Kilonzo & Ikamari (2015) argues poor record-keeping system which has led to the loss of a quantity of valuable information and patient uneasiness due and increasing waiting times for their file retrieval (Kilonzo & Ikamari, 2015). Therefore, there is a need to develop a paperless based filling system. This will eliminate the risk of losing medical records. Furthermore, it will reduce waiting time taken to look for hard copy files.