A multi-faceted intervention to promote breast cancer hormone receptor testing in Tanzania

坦桑尼亚促进乳腺癌激素受体检测的多方面干预措施

• 批准号: 10488254
• 负责人: Dianna L. Ng
• 金额: $ 25.14万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-13 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10488254
• 关键词: Address; Adopted; Adoption; Africa; Africa South of the Sahara; Biopsy; Breast Cancer Patient; Cancer Diagnostics; Cancer Etiology; Cessation of life; Clinical; Clinical Practice Guideline; Cluster randomized trial; Consolidated Framework for Implementation Research; Country; Data; Development; Development Plans; Diagnosis; Diagnostic; Diagnostic Services; Disease; District Hospitals; Environment; Estrogen Receptors; Estrogen receptor positive; Evidence based practice; Faculty; Focus Groups; Foundations; Funding; Future; Goals; Grant; Guidelines; Health Services Research; Hormone Receptor Test; Hospital Referrals; Hospitals; Improve Access; Income; Individual; Institution; Intervention; Knowledge; Laboratories; Malignant Neoplasms; Maps; Memorial Sloan-Kettering Cancer Center; Mentorship; Methods; National Comprehensive Cancer Network; Oncology; Outcome; Outcome Measure; Pathologic; Pathologist; Pathology; Patients; Physicians; Pilot Projects; Preparation; Progesterone Receptors; Prognosis; Progression-Free Survivals; Provider; Psychologist; Public Hospitals; Publishing; Quality of life; Reach Effectiveness Adoption Implementation and Maintenance; Recurrence; Research; Research Personnel; Resected; Resource-limited setting; Resources; Risk; Scientist; Services; Site; Structure; Surgical Oncologist; Survival Rate; Tanzania; Testing; Time; Training; United States National Institutes of Health; Unnecessary Surgery; Woman; adjuvant endocrine therapy; base; breast cancer diagnosis; breast cancer survival; cancer care; cancer therapy; care delivery; career; career development; clinical practice; disease classification; evidence base; formative assessment; global health; hormone receptor-positive; hormone therapy; implementation framework; implementation science; implementation strategy; improved; interest; low and middle-income countries; malignant breast neoplasm; member; mortality; multi-component intervention; multidisciplinary; organizational readiness; pilot test; skills; theories; treatment guidelines; treatment planning; uptake

PROJECT SUMMARY/ABSTRACT Breast cancer outcomes are disproportionately poor in low- and middle-income countries (LMICs) compared to high-income countries. Low breast cancer survival rates in LMICs are primarily attributable to advanced stage presentation and limited diagnostic and treatment capacity. Although national clinical practice guidelines for breast cancer in Tanzania recommend that all breast cancer patients receive hormone receptor (HR) testing, current pathology capacity is unable to meet this need. Pathologic diagnosis, including HR testing, is critical to determining the presence of cancer, extent of the disease, and planning treatment. However, HR testing is available at only two public hospitals in Tanzania. As a result, patients encounter turnaround times of weeks to months, with only a subset of eligible women receiving HR testing and guideline-concordant treatment. To reduce this evidence-to-practice gap, we propose to systematically identify the most effective implementation strategies across all public referral hospitals with pathology services in Tanzania to guide development of a multi-faceted and adaptable intervention (set of implementation strategies). We hypothesize that this intervention will increase the proportion of women who receive HR testing and guideline-concordant endocrine therapy, resulting in improved cancer care, quality of life, and overall short term survival of patients. First, we will conduct a formative evaluation to determine the organizational readiness for change and to identify barriers and facilitators to routine HR testing using mixed methods. Then, we will determine the optimal implementation strategies for the barriers and facilitators identified in the formative evaluation, and develop a multi-component intervention with methods informed by organizational theory. Finally, we will iteratively pilot test the multi-component intervention and will modify the intervention components based on outcomes measures. These studies will be led by Dr. Dianna L. Ng, a junior faculty member in the Department of Pathology at Memorial Sloan Kettering Cancer Center (MSK) with an interest in developing and testing theory-driven, multi-level interventions to increase integration of evidence-based cancer diagnostics in low-resource settings. The research will be carried out under the multidisciplinary mentorship of Dr. T. Peter Kingham (surgical oncologist, global oncology research), Dr. Jamie Ostroff (clinical psychologist, implementation science), Dr. Edda Vuhahula, (pathologist, capacity building in East Africa), and Dr. Britt-Marie Ljung (pathologist, resource- stratified diagnosis). MSK offers an outstanding environment for cancer care delivery and health services research. To achieve her goal of becoming an independent researcher, Dr. Ng has developed a structured career development plan aimed at advancing her knowledge and advanced skills in implementation science in global health.

项目摘要/摘要 低收入和中等收入国家（LMIC）的乳腺癌结果不成比例 与高收入国家相比。 LMIC的低乳腺癌存活率主要归因于 高级阶段表现和有限的诊断和治疗能力。尽管国家临床实践 坦桑尼亚乳腺癌指南建议所有乳腺癌患者接受激素受体 （人力资源）测试，当前的病理能力无法满足这一需求。病理诊断，包括人力资源测试， 对于确定癌症的存在，疾病程度和计划治疗至关重要。但是，人力资源 坦桑尼亚的两家公立医院只能进行测试。结果，患者遇到了周转时间 几周到几个月，只有一部分有资格接受人力资源测试和指导方案治疗的符合条件的妇女。 为了减少这一证据与实践差距，我们建议系统地确定最有效的 坦桑尼亚的所有公共转诊医院实施策略，以指导 开发多方面和适应性的干预措施（一组实施策略）。我们假设 这项干预将增加接受人力资源测试和指导方案的妇女的比例 内分泌疗法，导致癌症护理，生活质量和患者的总体短期生存。 首先，我们将进行形成性评估，以确定变更的组织准备和 确定使用混合方法常规HR测试的障碍和促进因子。然后，我们将确定 在形成性评估中确定的障碍和促进者的最佳实施策略，以及 通过组织理论告知的方法开发多组分干预措施。最后，我们会的 迭代试验测试多组分干预措施，并将根据 结果措施。 这些研究将由病理学系的初级教师Dianna L. Ng博士领导 在纪念斯隆·克特林癌症中心（MSK），对发展和测试理论驱动的兴趣， 多层干预措施以增加低资源环境中循证癌症诊断的整合。 该研究将在T. Peter Kingham博士的多学科指导下进行（手术 肿瘤学家，全球肿瘤研究），杰米·奥斯特罗夫（Jamie Ostroff）博士（实施科学临床心理学家），博士 Edda Vuhahula，（东非的病理学家）和Britt-Marie Ljung博士（资源，病理学家 - 分层诊断）。 MSK为癌症护理提供和卫生服务提供了杰出的环境 研究。为了实现成为独立研究人员的目标，NG博士开发了一个结构化的 职业发展计划旨在提高她的知识和高级技能，以实施科学 全球健康。