Formal Assessment of Teamwork Among Cancer Health Care Professionals in Three Large Tertiary Centers in Nigeria

Background: Cancer is a common cause of death in Low Middle-Income Countries. There have been strategies to bring quality cancer care to underserved patients around the world, but poor utilization of principles of teamwork is a major barrier to achieving quality services. The intent of this study was to assess teamwork as perceived by the health care workers caring for cancer patients. Methods: We conducted a survey among health care professionals involved in cancer care in three tertiary centers in the southwestern part of Nigeria from July to November 2016. Respondents rated teamwork using the previously validated Safety Attitudes Questionnaire. For this paper, we focused on the teamwork climate subscale which was scored on a scale of 0-100. We compared teamwork assessment by healthcare providers and institutions using analysis of variance and collaboration using logistic regression. Results: Overall 373 professionals completed the survey: physicians 177 (47%), nurses 51 (14%), pharmacists 21 (6%), lab technicians 31 (8%), and others 88 (33%). The average teamwork climate assessed across all professionals in the study was 70·5 (SD = 24·2). Pharmacists rated teamwork climate the lowest with a mean 63·9 (SD = 29·5), nurses and lab technicians rated teamwork high with means 74·5 (SD = 21·7) and 74·2 (SD = 27·1) respectively, and physicians rated teamwork lower 66·0 (SD = 23·6). Only 54·9% of physicians reported good collaboration among themselves, 52·9% of them reported good collaboration with nurses, and 44·9% reported good collaboration with pharmacists. 85·7% of nurses reported good collaboration amongst themselves, and collaboration with physicians and pharmacists were reported in 75·6% and 69·4% respectively. 76·2% Pharmacists reported good collaboration amongst themselves, and good collaboration with physicians and nurses were reported by 76·2% and 57·1% respectively. Interpretation: While overall teamwork scores were consistent with US ambulatory studies, there are important subgroup variations that provide targets for intervention. Physicians rated collaboration poorly both intra and inter professionally whilst pharmacists rated inter professional teamwork with nurses poorly. Efforts to transform cancer care need to focus on building trust among the key stakeholders, this is critical in low resource settings where there is a need to maximize the use of limited resources to improve patient outcomes. Funding Statement: The authors state: "This study was not funded by any organization." Declaration of Interests: All authors declared no competing interests. Ethics Approval Statement: This study was approved by Lagos State University Teaching Hospital (LASUTH), University of Ibadan(UCH), Lagos University Teaching Hospital (LUTH) and University of Chicago individual Institutions’ Review Boards.