Abstract

SAMUDIO, Angélica et al. Strategies for Preventing Patient Dropout in Children with Cancer in a Developing Country (Paraguay). Pediatr. (Asunción) [online]. 2013, vol.40, n.2, pp.119-123. ISSN 1683-9803.

Introduction: Patient dropout is defined as the interruption of treatment and contact with healthcare personnel for a period of more than 30 days. Objective: To describe the impact of strategies to reduce patient dropout used at the Department of Pediatric Hematology/Oncology at a reference hospital in Paraguay. Material and Methods: We conducted a longitudinal descriptive study of children diagnosed with cancer at our institution between January 2009 and August 2012. Results: In that period 404 patients were diagnosed with cancer, of whom 183 (45%) were from rural areas and 221 (55%) from the Asuncion metropolitan area, while 239 (59%) lived in shanty housing, and 165 (41%) in moderate housing, with families headed by married couples in 102 cases (25%), common law couples in 157 cases (39%), and a single parent in 145 cases (36%).  Families had more than 4 members in 285 cases (71%) and less than 4 members in 119 cases (29%). Family income was at least minimum wage in 103 (25%) homes and less than that in 301 (75%). Of the total sample, 327 (81%), met the criteria for classification as ‘at risk of refusal’ and 77 (19%) were deemed to be at no risk. Our efforts included 837 telephone contacts, 25 home visits, and 11 legal actions. Patient refusal fell gradually from 3/114 (2.6%) in 2009, to 1/132 (0.75%) in 2010, to 0/96 (0%) in 2011, and 1/64 (1.5%) in 2012. Discussion: The reduction in patient dropout in our study was possible due to a multidisciplinary effort that targeted not only the child diagnosed with cancer, but also his or her family and community.

Keywords : Patient dropouts; refusal of treatment; patient escort service.

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