Table 2 Codes extracted from interviews explored the experts’ perspectives on economic sanctions and cancer diagnosis and treatment in Iran
From: The impact of economic sanctions on cancer diagnosis and treatment in Iran: a qualitative study
Category | Sub-Category | Codes |
|---|---|---|
Input | Instability in financing mechanisms and regulations | • Stopping personalized medicine • Money Transfer Problems and refusal to join the Financial Action Task Force • Lack of access to required software due to money transfer problems • Formation of intermediary companies in neighboring countries for money transfer • Withdrawal of countries from working with Iran due to future consequences • Unable to purchase laboratory equipment due to an unopened site • In addition to that, due to airline sanctions, failure to send goods on time • Two years of waiting for access to the newly purchased device |
Shortage of materials | • Difficulty in the quantity and variety of contrast materials • Closure of vacuum biopsy devices due to lack of needles • Lack of diagnostic kits and the most minor consumables including suture yarn • Lack of diagnostic and therapeutic devices • Lack of medicine. | |
Low-quality imported materials | • Forced to supply required materials such as cobalt and iridium source from invalid sources with low-quality • Low-quality imported contrast materials from non-reliable sources • Using kits made from non-accredited brands to reduce access to trusted brands • Use of Low-Quality Alternative Drugs • Use of low-quality tools such as biopsy needles and staplers available | |
High prices of materials | • Increased prices due to the increase in the mediators • The devaluation of the country’s currency due to sanctions, followed by a multiple-fold increase in the price of consumer goods and equipment | |
Loss of human resources | • Reduced income of treatment teams and physicians’ migration • Anxiety and reduced motivation which results in suicides in some case | |
process | Delayed care | • Delay in diagnosis • Missed time of treatment due to delayed access to medicine |
Inadequate care | • Decreased quality and increased diagnosis error (results are not good due to inaccuracy of stage of disease in pet deficiency) • Transferring patients to the public sector. Due to financial limitations • Exclusion of private centers from providing services and bankruptcy of immunohistochemistry centers • Decrease in accuracy and quality of surgery • Biopsy quality loss (lower quality biopsy needle, lack of radioactive substance) • Withdrawal from Breast reconstruction due to prosthetic gravity | |
Non-adherence to guideline | • Changing the chemotherapy protocol due to a lack of medication (having to remove the drug from the protocol) • Impossible to apply knowledge of the day despite complete dominance • Ovarian removal in cases of diferline deficiency • Removing some surgical treatment steppes inevitably | |
Limited international collaborations | • Inability to participate in international clinical trials • Restricted access to articles, resources, and educational websites • Limited possibility to participate in international conferences and even inviting foreign professors due to financial limitations and restrictions on money transfer.” | |
Less Provider satisfaction | • Emergence of unpleasant feelings in the diagnostic team (team morale decline).” • Decrease in therapists’ expectations of drug quality. • Suffering from drug shortages at all stages of treatment • Feelings of helplessness and torment due to the use of unconventional methods | |
Output | Lower effectiveness | • Lower Ineffectiveness due to using invalid drugs |
More adverse events | • Occurrence of adverse events following the prescription of invalid drugs • Patient death due to the use of poor-quality blocking agents • Liver perforation due to the use of low-quality tools.” • Loss of ovaries due to deficiency of defibrillin. • Loss of anal sphincter due to lack of contour • Tumor recurrence due to incomplete and inaccurate removal of tumor tissue. • Patient harm due to the use of outdated equipment • Surgeon forced to remove kidney and ureter due to stone formation following the use of inappropriate equipment • Removal of a larger portion of tissue due to the inability to accurately mark the tumor | |
Increased equity gaps | • Increase in out-of-pocket payments by patients • Patients not seeking medical care and follow-up due to financial difficulties • Migration of patients to Turkey due to long waiting times for diagnosis and treatment. |