How Experts Are Forging a Path Through Consensus
Prostate cancer has quietly become one of the most significant yet overlooked health threats facing Ugandan men. While infectious diseases like HIV and malaria often dominate global health discussions, a silent crisis of prostate cancer is unfolding, with Ugandan men facing dramatically worse outcomes than their counterparts in developed nations.
A diagnosis that would be manageable in Europe or North America becomes effectively a death sentence in the Ugandan context 1 .
This healthcare disparity prompted a critical question: With limited resources and numerous challenges, where should Uganda focus its prostate cancer research efforts to have the greatest impact? The answer emerged through an innovative approach called the Delphi method, which harnessed the collective wisdom of Uganda's leading cancer experts to map a way forward 1 .
The Delphi method is a structured approach to harnessing the wisdom of experts to reach consensus on complex problems. Think of it as a refined, systematic version of "the wisdom of the crowd" - but instead of taking a simple poll, it uses multiple rounds of careful questioning and feedback to converge on the most important insights 1 3 .
Researchers assembled a diverse group of specialists including oncologists, urologists, cancer researchers, radiologists, and policy experts from various regions of Uganda 1 .
Initial statements about potential research priorities were drawn from comprehensive reviews of existing literature on cancer care barriers in sub-Saharan Africa 1 .
Experts anonymously scored each potential research priority based on specific criteria, then received feedback on the group's responses before reconsidering their scores in subsequent rounds 1 .
This method is particularly valuable when dealing with complex problems where evidence is limited or conflicting - exactly the situation with prostate cancer in Uganda. The anonymity of the process helps prevent dominant personalities from swaying the group, ensuring that each expert's voice carries equal weight 3 .
To identify the most critical research priorities for prostate cancer in Uganda, researchers implemented a meticulous two-round Delphi process between December 2021 and July 2022 1 . The study design intentionally included experts from various healthcare sectors, geographical locations, and medical specialties to ensure a comprehensive perspective.
Through this rigorous process, six critical research priority areas emerged that form the foundation for addressing prostate cancer in Uganda 1 :
| Priority Area | Key Challenges | Impact if Addressed |
|---|---|---|
| Diagnostic Services | Lack of ultrasound, laboratory tests, and biopsy facilities | Earlier detection, more accurate staging |
| Treatment Costs | High costs of surgery, radiotherapy, and hormone therapy | Increased treatment access for low-income patients |
| Essential Medicines | Unreliable supply of critical drugs | Consistent treatment continuity |
| Radiotherapy Capacity | Limited equipment and facilities | Improved treatment of advanced cancers |
| Public Awareness | Low recognition of cancer symptoms and risk factors | Earlier presentation and diagnosis |
| Healthcare Literacy | Limited understanding of when and how to seek care | Reduced delays in diagnosis |
The lack of critical surgical supplies and high diagnostic and treatment costs were ranked as the most urgent priorities in the first round of the study 1 .
The Ugandan study isn't an isolated case. Similar research conducted in Zambia using an almost identical methodology revealed strikingly parallel priorities, suggesting a regional pattern of healthcare system challenges 8 .
| Research Priority | Uganda Ranking | Zambia Ranking |
|---|---|---|
| Affordable diagnostic capacity | Top priority | Top priority |
| Cost of treatments | Top priority | Top priority |
| Access to essential medicines | Top priority | Included |
| Public awareness | Included | Top priority |
| Staff training | Not top ranked | Included |
| Healthcare coordination | Not top ranked | Included |
Both countries identified building affordable high-quality diagnostic capacity and addressing the affordability of specialist cancer treatments as critical priorities 1 8 . This convergence suggests that solutions developed in one sub-Saharan African country might be successfully adapted to others facing similar challenges.
The Ugandan prostate cancer study employed a sophisticated evaluation framework to assess potential research priorities. Understanding this "toolkit" reveals how experts made their determinations about where to focus limited research resources 1 8 .
| Evaluation Criteria | What It Measures | Application in the Study |
|---|---|---|
| Feasibility | How easily the area can be studied empirically | Determined if research could be practically conducted in Uganda |
| Large Scale | The proportion of prostate cancer patients affected | Ensured priorities would benefit many patients, not just small subgroups |
| High Impact | Significance in causing death or disability from prostate cancer | Focused on factors with greatest effect on patient outcomes |
| Modifiable | Potential for meaningful improvement through intervention | Eliminated factors unlikely to change even with research findings |
Each potential research area was scored 1-5 on each criterion, creating a total score out of 20. This structured approach forced experts to think beyond their personal interests or clinical specialties and focus on what would deliver the greatest benefit to the broadest population of Ugandan men with prostate cancer 1 .
The true value of this consensus process lies in its potential to guide future research and funding toward the areas of greatest need. As one study participant noted:
The findings provide a strategic roadmap for researchers, policymakers, and funders looking to make a meaningful impact on prostate cancer outcomes in Uganda.
International donors and research funders can now direct resources toward the identified priorities rather than potentially less relevant areas.
The study highlights the importance of developing local research expertise tailored to Ugandan healthcare challenges.
The Zambian example shows how such research priorities can directly inform National Cancer Control Plans 8 .
The consistent priorities across countries suggest opportunities for regional approaches to solving common problems.
The Ugandan prostate cancer research prioritization study represents a significant step forward in the battle against this devastating disease. By systematically identifying where research efforts will have the greatest impact, Uganda can avoid wasting precious resources on less relevant questions and instead focus on solving the fundamental barriers to timely diagnosis and effective treatment.
As the study concludes, "There is need to improve the supply of high-quality affordable anticancer medicines for prostate cancer patients so as to improve the survivorship from the cancer" 1 . This Delphi consensus process has lit the path toward that goal, offering hope that strategic research focused on the right priorities can eventually close the dramatic gap in prostate cancer outcomes between Uganda and higher-income countries.
The success of this approach also offers a model that could be applied to other neglected health issues in resource-limited settings, demonstrating how structured expert consensus can create clarity amid complexity and point the way toward meaningful progress in global health equity.
References will be added here in the final publication.