Healthcare stakeholders’ perspectives on coordinating cancer diagnosis in Chile, Colombia, and Ecuador

Objective: To explore healthcare stakeholders' experiences of care coordination during cancer diagnosis in Chile, Colombia, and Ecuador, including how these experiences are influenced by factors related to the countries' public subsystems.

Methods: A qualitative study was conducted based on 115 semi-structured interviews with healthcare professionals and administrative personnel in both primary care (n = 40) and secondary/tertiary care (n = 46) as well as managers and policymakers (n = 29). Thematic analysis, guided by a care coordination framework, was performed first per country and then across countries.

Results: The analysis points to limited transfer of clinical information causing repeated tests as well as poor clinical management coordination in terms of delayed referrals from primary care and restricted access to specialized care, altogether contributing to diagnostic delays. Self-reinforcing loops of barriers for care coordination included fragmented clinical information systems, poor skills and training among healthcare professionals, as well as insufficient diagnostic equipment in all three study countries, scarcity of specialized healthcare professionals and functioning of the prioritization system for certain cancers in Chile, and working conditions and insurance companies' management of care in Colombia. Informal communication strategies and personal networks emerged as adaptive responses to these challenges, facilitating coordination in some cases but also risking data security and consistency in care.

Conclusions: The study highlights the urgent need for political prioritization of cancer care coordination, including investments in unified clinical record systems, training of healthcare professionals, and diagnostic infrastructure. It also emphasizes the importance of recognizing healthcare stakeholders' responses to barriers.