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.

项目概要/摘要 低收入和中等收入国家 (LMIC) 的乳腺癌预后较差 与高收入国家相比。中低收入国家乳腺癌存活率低的主要原因是 晚期表现和有限的诊断和治疗能力。虽然国内临床实践 坦桑尼亚乳腺癌指南建议所有乳腺癌患者接受激素受体治疗 （HR）检测，目前的病理能力无法满足这个需要。病理诊断，包括HR测试， 对于确定癌症的存在、疾病的程度和规划治疗至关重要。然而，人力资源部 坦桑尼亚只有两家公立医院提供检测。因此，患者的周转时间为 几周到几个月，只有一小部分符合条件的女性接受了 HR 测试和符合指南的治疗。 为了缩小这种证据与实践之间的差距，我们建议系统地确定最有效的方法 指导坦桑尼亚所有设有病理学服务的公立转诊医院的实施战略 制定多方面且适应性强的干预措施（一套实施战略）。我们假设 这项干预措施将增加接受人力资源测试并符合指南的女性比例 内分泌治疗，从而改善癌症护理、生活质量和患者的整体短期生存。 首先，我们将进行形成性评估，以确定组织对变革的准备情况和 使用混合方法确定常规人力资源测试的障碍和促进因素。然后，我们将确定 针对形成性评估中确定的障碍和促进因素的最佳实施策略，以及 采用组织理论指导的方法制定多成分干预措施。最后，我们将 迭代地试点测试多成分干预，并将根据情况修改干预成分 结果措施。 这些研究将由病理学系初级教员 Dianna L. Ng 博士领导 在纪念斯隆凯特琳癌症中心 (MSK) 工作，对开发和测试理论驱动的、 多层次干预措施，以增加资源匮乏环境中基于证据的癌症诊断的整合。 该研究将在 T. Peter Kingham 博士（外科 肿瘤学家，全球肿瘤学研究），Jamie Ostroff 博士（临床心理学家，实施科学），Dr. Edda Vuhahula（病理学家，东非能力建设）和 Britt-Marie Ljung 博士（病理学家，资源- 分层诊断）。 MSK 斯隆为癌症护理服务和健康服务提供卓越的环境 研究。为了实现成为一名独立研究员的目标，吴博士开发了一个结构化的 职业发展计划旨在提高她在实施科学方面的知识和高级技能 全球健康。