Improving Access To Cancer Control Services In Low- And Middle-income Countries; A Novel Framework On Policy Change For Pharmacists’ Involvement

• By: CHUKWU, Otuto Amarauche (University of Toronto, Institute of Health Policy, Management and Evaluation, Canada)
• Co-author(s): Mr Otuto Amarauche Chukwu (University Of Toronto, Toronto, Canada)
  Prof. Beverley Essue, Institute of Health Policy, Management and Evaluation (University Of Toronto, Toronto, Canada)
  
• Abstract:

  Background
  Cancer, a complex global health issue, is overburdening healthcare systems globally. It is the second most common cause of death and could claim 76 million more lives over the next decade, especially in low- and middle-income countries (LMICs). This high burden of cancer is driven by critical shortage of oncologists and poor access to diagnosis and treatment leading to late disease presentation, hence poor prognosis. Consequently, exploring strategies to improve access to cancer control is key. One such strategy is task shifting, a critical health system strengthening approach that optimizes efficient use of human resources. However, evidence on how task shifting, involving advanced clinical professionals like pharmacists, could improve access to cancer control services is lacking.
  
  Purpose
  Because pharmacists, through their proximity to communities, could play a significant role in improving access to cancer control services, we sought to develop a conceptual framework for task shifting to pharmacists to determine its feasibility in improving access to cancer control.
  
  Methods
  We conducted an initial systematic review to ascertain what is known from the existing literature about the effectiveness of task shifting of cancer control services to nonphysician health workers. The findings showed the scope of roles that have been shifted to nonphysician health workers and further suggests that it could be effective in improving access to cancer control services. However, most of the tasks were shifted to less advanced health workers such as community health workers, and primary healthcare workers.
  With findings showing limited research on task shifting to advanced clinical practice professionals like pharmacists, we saw the need for further research on how the critical elements of care required along the cancer control continuum can be shifted to pharmacists. Such research requires a critical framework for understanding the organizational readiness for change involving oncologists, pharmacists, policymakers, and patients and how the development of a new model of care to improve access to cancer control services can be supported.
  Using three theoretical structures comprising intellectual capital theory, organizational readiness for change theory and the theoretical domains framework, we developed a framework for exploring readiness for pharmacists’ involvement in cancer control.
  
  Results
  We propose the Task Shifting Concepts for Pharmacists to Advance Cancer Control and Treatment (TASK PACT) framework. It synthesizes key theoretical concepts that can explore oncologists, pharmacists, policymakers, and patients’ readiness for task shifting in LMICs. By exploring the factors that influence oncologists, policymakers, pharmacists and patients’ perspectives for task shifting to pharmacists, relevant information for developing a new model of care to improve access to cancer control services could emerge.
  
  Conclusion
  Even though there are studies that have explored or advocated for roles for pharmacists in cancer care, there is, to the best of our knowledge, no framework to explore the development of an actual model of care for pharmacists to improve access to cancer control services. Therefore, we believe that this framework could provide a good starting point for significant involvement of pharmacists in addressing the burgeoning cancer epidemic.