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Clark K1, Gamble A1,2, Farroni L3
1Boston Biopharma, Corporate and Social Responsibility, Alpharetta, United States, 2Side by Side Global, Sulaymaniyah, Iraq, 3University of Texas Medical Branch, Department of Physical Therapy, Galveston, United States
Background: Oncology care within the semi-autonomous Kurdistan region of Iraq (Kurdistan) has developed within the past 10 years and has been recognized as an “emerging cancer hub” within greater Iraq. In 2016, the Kurdistan Regional Government Ministry of Health (MOH) reported 5,085 new cases of cancer within Kurdistan.
Regarding oncological care, the American College of Sports Medicine Roundtable concluded that exercise training is safe during and after cancer treatment and results in improvements in physical functioning, quality of life, and cancer-related fatigue. Further studies have demonstrated that increased activity levels can result in lower mortality in survivors of cancer and help reduce recurrence of specific cancers. Therefore, it is critical to enhance the utilization of physical therapy and rehabilitation services in oncology care in Kurdistan.
Purpose: This case report describes a continuing professional development (CPD) program that aims to implement sustainable and culturally relevant capacity building activities that expand access to and enhance the quality of Kurdistan's cancer rehabilitation services.
Methods: A program to establish sustainable high-quality oncologic rehabilitation services in Kurdistan includes the following components:
1. Needs Assessment - focus group discussions with key stakeholders including MOH and hospital leadership, clinical staff, and patient population representatives
2. Implementation of Capacity Building Activities - design, develop and deliver clinical education incorporating best practice and the needs of the stakeholders
3. Utilize a Train the Trainer Model - establish a peer support system to promote sustainability
4. Monitoring and Evaluation of Outcomes - implement culturally relevant evaluation mechanisms
Results: Over 20 hours of preliminary needs assessment activities were conducted at MOH hospitals that provide cancer care in Kurdistan's three major cities, revealing that rehabilitation services for persons with cancer are non-existent or severely underutilized throughout the region. Factors contributing to this gap were described as a lack of the following:
1. awareness of evidence-based recommendations,
2. trained healthcare staff,
3. infrastructure, and
4. awareness in the community.
Additional considerations noted for the three communities included differences in language, diverse cultural norms, and the unique contextual and cultural needs of refugees and internally displaced persons.
Subsequently, based on the stakeholders' feedback, preliminary implementation of capacity building activities was conducted in the three Kurdistan cities via a 3-hour introductory CPD course. A total of 45 physiotherapists, oncologists, oncology nurses, and hospital decision-makers attended the course. Pre-test data from this course revealed an initial lack of knowledge in cancer rehabilitation best practice followed by an almost 40% improvement on the post-test score.
Conclusion(s): As a result of the needs assessment and initial capacity building activities, the leadership from all government cancer hospitals have requested to formalize the program with a one-year regional capacity building initiative. The three hospital systems, MOH, and the private organization directing the training have successfully collaborated to develop and submit a proposal with the goal of developing sustainable oncologic rehabilitation services in Kurdistan.
Implications: This project offers an example of how private organizations can collaborate with local communities to promote sustainable oncologic rehabilitation services through the provision of culturally and contextually relevant capacity building activities.
Keywords: capacity building, continuing professional development, cancer rehabilitation
Funding acknowledgements: This project was funded by the Corporate and Social Responsibility Division of Boston Biopharma, USA.
Regarding oncological care, the American College of Sports Medicine Roundtable concluded that exercise training is safe during and after cancer treatment and results in improvements in physical functioning, quality of life, and cancer-related fatigue. Further studies have demonstrated that increased activity levels can result in lower mortality in survivors of cancer and help reduce recurrence of specific cancers. Therefore, it is critical to enhance the utilization of physical therapy and rehabilitation services in oncology care in Kurdistan.
Purpose: This case report describes a continuing professional development (CPD) program that aims to implement sustainable and culturally relevant capacity building activities that expand access to and enhance the quality of Kurdistan's cancer rehabilitation services.
Methods: A program to establish sustainable high-quality oncologic rehabilitation services in Kurdistan includes the following components:
1. Needs Assessment - focus group discussions with key stakeholders including MOH and hospital leadership, clinical staff, and patient population representatives
2. Implementation of Capacity Building Activities - design, develop and deliver clinical education incorporating best practice and the needs of the stakeholders
3. Utilize a Train the Trainer Model - establish a peer support system to promote sustainability
4. Monitoring and Evaluation of Outcomes - implement culturally relevant evaluation mechanisms
Results: Over 20 hours of preliminary needs assessment activities were conducted at MOH hospitals that provide cancer care in Kurdistan's three major cities, revealing that rehabilitation services for persons with cancer are non-existent or severely underutilized throughout the region. Factors contributing to this gap were described as a lack of the following:
1. awareness of evidence-based recommendations,
2. trained healthcare staff,
3. infrastructure, and
4. awareness in the community.
Additional considerations noted for the three communities included differences in language, diverse cultural norms, and the unique contextual and cultural needs of refugees and internally displaced persons.
Subsequently, based on the stakeholders' feedback, preliminary implementation of capacity building activities was conducted in the three Kurdistan cities via a 3-hour introductory CPD course. A total of 45 physiotherapists, oncologists, oncology nurses, and hospital decision-makers attended the course. Pre-test data from this course revealed an initial lack of knowledge in cancer rehabilitation best practice followed by an almost 40% improvement on the post-test score.
Conclusion(s): As a result of the needs assessment and initial capacity building activities, the leadership from all government cancer hospitals have requested to formalize the program with a one-year regional capacity building initiative. The three hospital systems, MOH, and the private organization directing the training have successfully collaborated to develop and submit a proposal with the goal of developing sustainable oncologic rehabilitation services in Kurdistan.
Implications: This project offers an example of how private organizations can collaborate with local communities to promote sustainable oncologic rehabilitation services through the provision of culturally and contextually relevant capacity building activities.
Keywords: capacity building, continuing professional development, cancer rehabilitation
Funding acknowledgements: This project was funded by the Corporate and Social Responsibility Division of Boston Biopharma, USA.
Topic: Oncology, HIV & palliative care; Oncology, HIV & palliative care; Globalisation: health systems, policies & strategies
Ethics approval required: No
Institution: University of Texas Medical Branch
Ethics committee: Institutional Review Board
Reason not required: The project does not meet the definition of 'human subject research'
All authors, affiliations and abstracts have been published as submitted.
