Interventions to increase adherence to cervical cancer early detection and treatment recommendations in Mexico City clinics

墨西哥城诊所采取干预措施，提高对宫颈癌早期检测和治疗建议的遵守率

• 批准号: 10528196
• 负责人: DONNA L SPIEGELMAN
• 金额: $ 34.14万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10528196
• 关键词: Address; Adherence; Administrator; Biometry; Cancer Control; Cancer Detection; Cancer Etiology; Cancerous; Caring; Cervical; Cervical Cancer Screening; Chronic Disease; Cities; Clinic; Clinical; Clinical Practice Guideline; Colposcopy; Consolidated Framework for Implementation Research; Country; Data; Data Collection; Detection; Diagnosis; Diagnostic; Early Diagnosis; Early treatment; Education; Evaluation; Feedback; Future; Goals; Guideline Adherence; Guidelines; Health Personnel; Healthcare Systems; Hispanic; Incidence; Income; Information Systems; Intervention; Latin America; Lesion; Logic; Malignant neoplasm of cervix uteri; Methods; Mexican; Mexico; Modeling; Not Hispanic or Latino; Outcome; Patients; Primary Prevention; Process; Protocols documentation; Provider; Recommendation; Research; Resource-limited setting; Resources; Secondary Cancer Prevention; Self Management; System; Testing; Time; Woman; World Health Organization; adherence rate; base; cancer care; cancer health disparity; cancer prevention; cancer therapy; cervical cancer prevention; clinical decision support; design; dissemination science; evidence base; follow-up; health belief; health care service organization; implementation determinants; implementation outcomes; implementation science; implementation strategy; implementation study; implementation trial; improved; interest; low and middle-income countries; mortality; premalignant; programs; response; scale up; screening; screening guidelines; success; treatment guidelines; treatment program

Project summary/Abstract Despite being highly preventable, stark cervical cancer (CC) disparities exist globally. CC is the second leading cause of cancer mortality among Mexican women, where CC detection, diagnosis, and treatment delays result from suboptimal implementation of and adherence to longstanding Mexican early detection, diagnosis, and treatment guidelines, which have been in existence since 1974. In contrast, CC is the 12th leading cause of cancer mortality among women in the US, where evidence about patient, provider, and health care organizational factors associated with adherence to CC early detection and diagnosis recommendations likely associated with the success of CC control programs has accrued. In Mexico, screening rates are suboptimal (50-67%), in contrast to 80% in the US, and follow-up colposcopy among Mexican women with abnormal screens is 43%, in contrast to around 66%-71% in the US. In response to NOT-CA-20-025 Notice of Special Interest (NOSI): Dissemination and Implementation Science for Cancer Prevention and Control in Low Resource Environments, we propose to identify barriers to and facilitators of adherence to the Mexican guidelines for follow-up from an abnormal screen onward down the CC care cascade (MGMACS, Mexican Guidelines for Managing Abnormal Cervical Cancer Screening Tests), and to develop strategies to increase adherence to these guidelines in clinics in Tlalpan, a Southern district of Mexico City. Following an Implementation Mapping approach, guided by the Consolidated Framework for Implementation Research (CFIR), the Health Belief Model, and the Implementation Outcomes Framework (IOF), we will evaluate the determinants of implementation and outcomes of the current MGMACS implementation and develop a logic model describing the process for improving adherence to the MGMACS from abnormal screens onwards down the cascade, among patients, providers, and clinics (Aim 1). Next, we will select and adapt implementation strategies that address the barriers identified to improve adherence to MGMACS (Aim 2). In both aims, we will use qualitative and quantitative methods for data collection and synthesis of findings, embedding them together in a multistage integrated convergent mixed methods design and analysis approach. Our study team has extensive research expertise in biostatistics, implementation science methods and practice, and CC prevention and control in Mexico and elsewhere. We aim to gather data to inform a future external application for a large-scale implementation study on improving adherence to MGMACS. This project will provide a model for an implementation science-based approach to improving CC early detection, diagnosis, and treatment programs in similar under-resourced contexts in Latin America and beyond, contributing to the reduction and ultimate elimination of CC.

项目摘要/摘要 尽管高度可预防，但在全球范围内存在严重的宫颈癌（CC）差异。 CC是第二大领先 墨西哥妇女的癌症死亡率，CC检测，诊断和治疗延迟的原因 从次优的实施和依从性到长期存在的墨西哥早期发现，诊断和 自1974年以来一直存在的治疗指南。相比之下，CC是第12个主要原因 美国妇女的癌症死亡率，有关患者，提供者和医疗保健的证据 与CC遵守CC早期检测和诊断建议相关的组织因素可能 与CC控制计划的成功相关联。在墨西哥，筛查率是次优的 （50-67％），与美国80％相比，墨西哥妇女异常的后续阴道镜检查 屏幕为43％，相比之下，在美国约为66％-71％。响应非CA-20-025特殊通知 兴趣（NOSI）：低低的癌症预防和控制的传播和实施科学 资源环境，我们建议确定遵守墨西哥的障碍和促进者 从CC Care Cascade（MGMAC，墨西哥）开始的异常屏幕的后续指南 管理异常宫颈癌筛查测试的指南），并制定策略以增加 遵守墨西哥南部地区特拉尔彭诊所的这些准则。遵循 实施映射方法，在实施研究的合并框架的指导下 （CFIR），健康信念模型和实施成果框架（IOF），我们将评估 实施的决定因素和当前MGMAC实施的结果并开发逻辑 描述从异常屏幕向下降低粘膜依从性的过程的模型 在患者，提供者和诊所中的级联（AIM 1）。接下来，我们将选择并调整实施 解决障碍以提高遵守MGMAC的障碍的策略（AIM 2）。在这两个目标中，我们都会 使用定性和定量方法进行数据收集和综合，将其嵌入 在多阶段集成收敛的混合方法设计和分析方法中一起。我们的学习团队 在生物统计学，实施科学方法和实践中拥有广泛的研究专业知识，以及CC 墨西哥和其他地方的预防和控制。我们旨在收集数据以告知未来的外部应用 有关改善粘膜依从性的大规模实施研究。该项目将提供模型 用于改善CC早期检测，诊断和治疗的实施方法 在拉丁美洲及其他地区类似背景下不同背景下的计划，有助于减少和 最终消除CC。

项目成果

Factors associated with receiving results and attending colposcopy in patients with positive HPV screens in Mexico City.

• DOI: 10.1016/j.pmedr.2023.102347
• 发表时间: 2023-10
• 期刊: PREVENTIVE MEDICINE REPORTS
• 影响因子: 2.8
• 作者: Leon-Maldonado, Leith;Hernandez-Ramirez, Raul U.;Torres-Ibarra, Leticia;Spiegelman, Donna;Sheth, Sangini S.;Lazcano, Eduardo;Cadena-Fiscal, Jose D.;Salmeron, Jorge
• 通讯作者: Salmeron, Jorge