Leveraging Mobile Phone Navigation for Cancer Care Continuity and Support During the COVID-19 Pandemic at Kenyatta National Hospital

November 2020 Vol 11, No 11
Catherine Nyongesa, MbChB, FC RAD ONCO, MMED RAD ONC
Kenyatta National Hospital,
Nairobi, Kenya
Anastacia Bosire, MScN Onco
Kenyatta National Hospital,
Nairobi, Kenya
Grace Omulogoli, BSc, HSM
Kenyatta National Hospital
Nairobi, Kenya
Ronniey Obulemire, MPH
Kenyatta National Hospital,
Nairobi, Kenya
Hayley Freedman, MPH
American Cancer Society,
Washington, DC
Erica Krisel, MPH
American Cancer Society,
Atlanta, GA

Background: Kenyatta National Hospital (KNH) is the main public hospital in Kenya delivering comprehensive cancer care and receives patients from throughout the country. The patient navigation program, established in 2017, addresses barriers to accessing timely care at the Cancer Treatment Centre (CTC) and several clinics. The COVID-19 pandemic disrupted cancer healthcare systems worldwide and posed additional challenges to cancer patients in Kenya. In March 2020, the government instituted control measures, including a travel ban that along with other factors led to a 50% reduction in the number of patients able to access care at the CTC. In response, patient navigators expanded use of mobile phone calls to support cancer patients and ensure continuity of care.

Objective: This presentation provides a summary of the challenges cancer patients encountered with accessing care during the COVID-19 pandemic identified through mobile phone calls and describes how the use of telephone navigation addressed them.

Methodology: From March to April 2020, navigators called patients to check in on them and also received calls from patients and caregivers. Call date, reason for the call, and other comments about the discussion were recorded in paper phone call logs. Data from 230 calls with cancer patients were reviewed. Call reasons and support provided were grouped into themes and summarized using descriptive statistics.

Results: In 39% (n = 89) of the calls, patients were afraid or worried that traveling to KNH was going to expose them to COVID-19. More than a quarter (28%, n = 63) were to attend a follow-up clinic and shared that they were not planning to come out of fear of contracting COVID-19, whereas in 13% (n = 29) of the calls, patients said they thought that the cancer services had been suspended. Patients were informed that preventive measures were in place, and that the services were continuing. Forty-four percent (n = 101) reported challenges in accessing services at KNH due to imposed movement restrictions and the inability to afford transportation costs. Navigators assisted by rescheduling nonurgent appointments or by providing letters explaining their medical need for clearance to travel. Seventeen percent (n = 40) reported experiencing pain but being unable to access their usual pain medication because of travel restrictions. They were linked to the nearest health facility for pain management, and those near Nairobi were assisted to access KNH. Thirteen percent (n = 31) reported experiencing other symptoms or side effects and were advised on their management. Those needing medical attention were advised to come to KNH or were linked to the nearest health facilities.

Conclusion: The COVID-19 pandemic significantly affected cancer patients’ ability to access cancer care. Phone calls have been instrumental in ensuring cancer care continuity by addressing patients’ unique needs due to the pandemic in addition to the usual barriers. Mobile calls enabled navigators to optimize their provision of quality patient-centered care, and they can continue to leverage this resource for enhanced patient support.

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