A Qualitative Study of the Impact of COVID 19, on Health Care Providers for Cancer Patients: An Original Research.

INTRODUCTION: In the challenging times of the COVID-19, the care of individuals with the debilitating diseases such as cancers has been an additional burden to the medical team. We aim to find out about the obstacles for the clinical care of the patients in the COVID, the questions frequently asked by cancer patients, and the medical care and support teams' general experience in taking care of cancer patients during the times of the pandemic.
MATERIALS AND METHODS: We conducted a Qualtrics survey that was developed by Cancer and Aging Research Group among 275 health care providers to cancer patients during. There were twenty questions in the survey. Of these 20, three open-ended questions were included that inquired about the barriers to the clinical care of cancer patients during COVID-19; the questions asked to the health care team by cancer patients or the attendants; health care teams general experience in the situations of the COVID-19. Two different reviewers performed the quality analysis for the open-ended questions after they were assigned a code. SPSS ver-23 was used for the descriptive statistics.
RESULTS: Medical services organizational difficulties and addressing necessities and support were generally reported. Hindrances to the medical health teams included the included administrative difficulties, access of the patient to the support and basic resources, uncertainties for patients' psychological and physical well-being, and teleconsultation challenges. The most common concern of the patients was the safety and the need for the treatment. Medical health care teams were seen to worry for the mental and the physical health of cancer patient. There was also reported concern for the medical team's own safety, obstruction in multi-level establishments; also the health team was seen feeling positive leadership and communications.
CONCLUSION: The medical health provider teams felt a need for thorough support at the organizational level for cancer patients. Medical teams were expected to comprehend the short-term and long-term impact of the COVID-19 on cancer patients. It was accepted that there has been an increased workload and mental stress among the providers. Appreciating the experiences of the medical teams during the pandemic may help in the future guidance in the care of cancer patients. Copyright:

INTRODUCTION

In the challenging times of the COVID-19, the care of individuals with the debilitating diseases such as cancers has been an additional burden to the medical team. The health care team needs greater supports from the federal government to manage cancer patients who are undergoing treatment are more in danger than usual times. In doing these tasks, the medical team is already reached a high emotional stress level.[12] Furthermore, there has been a shift in the practice methods do to the ever-evolving pandemic protocols, that may influence the treatment outcomes in cancer patients.[3] Moreover, being the first means of medical help and advice to the patients the medical team has always been at the risk of the burnout irrespective of the pandemic.[45] Hence, in the present study, we aim to find out about the obstacles for the clinical care of the patients in the COVID, the questions frequently asked by cancer patients, and the medical care and support teams' general experience in taking care of cancer patients during the times of the pandemic.

MATERIALS AND METHODS

We conducted a Qualtrics survey that was developed by Cancer and Aging Research Group among 275 health care providers to cancer patients during. There were twenty questions in the survey. Of these 20, three open-ended questions were included that inquired about the barriers to the clinical care of cancer patients during COVID-19; the questions asked to the health care team by cancer patients or the attendants; health care teams general experience in the situations of the COVID-19. After taking the consent, questionnaire was given to the participants that was prepared from the previous questionnaire studies and noted using Google Forms. The present study was given clearance as it did not involve any human research and as no classified data was procured from the participants. Two different reviewers performed the quality analysis for the open-ended questions after they were assigned a code.[6] SPSS ver-23 (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. IBM Corp. Released 2016) was used for the descriptive statistics.

RESULTS

Out of the 275 participants in our study, the majority were doctors and social workers (~70%). Equal distribution of the experience of the healthcare team was seen with all the groups having above 15 years of experience. The majority were under government programs (~60%) with very few attending the private programs. As the majority of the treatment centers are in the cities in our study also more than half of the personnel were in the urban setup [Table 1].

Table 1

Distribution of the participants

Variable	Percentage
Occupation
Doctors	28.4
Social workers	43.5
Various professions	6.31
Program administrators	8.13
Other allied paramedical team	9.25
Guides	5.11
Experience
1-5	20.5
6-10	24.2
11-19	28.9
20 and over	26.4
Types of hospitals
Central cancer center	36.5
Public cancer program	29.1
Government hospital	17.2
Empaneled hospital	7.3
Private cancer hospitals	4.2
Private general clinics	0.3
Others	5.7
Location of treatment center
Rural	15.3
Semi-urban	30.2
Urban	54.5

Open-ended questions

Barriers to the clinical care in the COVID-19-five barriers were noted in the present study.

Administrative barriers to provide care, availability of support to the patients, mental health of the patient, physical health condition of the patient, and teleconsultation challenges.

In the administrative barriers, there were supply deficit of the PPE kits, delayed appointments, delayed diagnostics, no direct programs to educate cancer patients, and attendants, restriction of the patient attendants due to the fear of contagion. Due to the restriction on transport, the access of the health providers to the patient has decreased in the COVID-19. Allowance during the treatment under the government schemes was also delayed due to the pandemic. Many participants reported the mental stress faced by the patients due to the restriction of the visits in the pandemic. Many patients felt isolated and anxious. Few patients were also unwilling to attend the treatment appointments due to fear of infection. With advent of the internet, there has been a surge in the teleconsultation services. However as many of cancer patients are senior citizens, reluctance has been reported toward telehealth appointments. Furthermore, there was lesser access to the internet in the rural area.

Many social workers reported that the patients undergoing the treatment for cancer was immune-compromised and were feared to be at risk of the infection and associated COVID-19 complication. With reference to the second open-ended question, asked by patients to the health providers were of three categories, about health care, basic needs, and future. Many participants reported that they faced the most common question about the safety during the visit to attend the treatment. Many patients were apprehensive of the benefits of the treatment over the infection of COVID. The patients also were concerned about the safe way to procure the basic needs such as food and medication. Many participants reported that patients were eager to return to Normalcy so that the visitors can attend them and they can have a normal life.

With respect to the third open-ended question, the experiences of the health care teams during the pandemic, many participants were outspoken and considerate about their experiences. The experiences were observed in the following categories mental and physical health of the patients, personal safety issues of the health care providers, dissatisfactory responses at different levels in the administration, some had a positive feeling with the cooperation from the colleagues. Many participants reported an increase in the workload and increased fear and frustration among the health providers. Some participants reported a positive feedback as they have experienced better teamwork and ability of the staff during the crisis.

DISCUSSION

In the present study, we intend to investigate the obstructions to clinical care, the patient's and the attendees' inquiries, and the general encounters of medical services providers to cancer patients in the pandemic time. We found that there have been many clinical restrictions to the care that included administrative to personal hindrances during the COVID-19. These findings show a need to ensure a continued flow of care and to improve the framework of patient access. Keeping in mind the goodwill of the institute, the health care team and the patients, the health care providers, doctors should consider simple interventions and hence defer the exposure to the infection during the patient visit.[7] Extra provision for teleconsultation and the basic amenities along with the safe transport should be set up, financially upheld, and imparted to the medical care team and patients. This correspondence is appropriate, as it will guarantee more patients with malignancies receive a better care. We also noticed that over their own and their family's well-being, medical care teams were more concerned with their patient's security and their associate's mental health wellness. This outlines the dedication the health care providers have toward their patients. As there is no known protocol of treatment for COVID-19, there has been a significant exhaustion among the health care providers and the support team. There is also a need for the support ten to take care of their mental and physical wellness.[891011] The encounters of the medical team were significant and show the contrast of the COVID-19 pandemic. In our observation, we discovered that the health care providers were flexible and selfless, the contemplation of clinical groups, and the sound authority from health care teams was visible. Notwithstanding, respondents additionally felt that administrations from at various levels have failed to provide the basic amenities like PPE. There should be easy access to the support for both the medical team and the patients to have a good prognosis of the treatment and also for the physical and mental well-being of the health care providers. The lessons learned from the pandemic should be evidence based. The role being played by the health care teams should be thoroughly recognized and appreciated.[12] There were few limitations in our study like the disparity in the healthcare team distribution with the social worker and the doctors and the urban areas constituting the largest in the sample. The participants were from a single country; hence the results from our study are difficult to be generalized to other zones.

CONCLUSION

Our study elaborated the views during the COVID pandemic, of the health care team of cancer patients. There were few revelations in our study, where the medical health provider teams felt a need for thorough support at the organizational level for cancer patients. The most common question faced by the health care team from the patients or their attendants was related to the need for treatment and the safety during COVID. The medical team was expected to comprehend the short-term and long-term impact of the COVID on cancer patients. It was accepted that there has been an increased workload and mental stress among the providers. Appreciating the experiences of the medical teams during the pandemic may help in the future guidance in the care of cancer patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.