Evaluating scaleup of an adapted breast cancer early diagnosis program in Rwanda

评估卢旺达适应性乳腺癌早期诊断计划的扩大规模

• 批准号: 10372496
• 负责人: Lydia Pace
• 金额: $ 20.54万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-08 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10372496
• 关键词: Adoption; Africa South of the Sahara; Age; Area; Awareness; Breast; Breast Cancer Early Detection; Bundling; Cancer Control; Caring; Cervical Cancer Screening; Cessation of life; Clinic; Clinical; Communities; Community Health Aides; Community Outreach; Computerized Medical Record; Controlled Study; Country; Diagnosis; Diagnostic; Diagnostic Services; Disease; District Hospitals; Early Diagnosis; Effectiveness; Evaluation; Exploration Preparation Implementation and Sustainment; Health; Healthcare; Healthcare Systems; Hospitals; Hybrids; Incidence; Income; Interruption; Intervention; Intervention Studies; Interview; Link; Literature; Malignant Neoplasms; Modeling; National Cancer Institute; Outcome; Patients; Perception; Policies; Primary Health Care; Program Effectiveness; Program Sustainability; Provider; Qualitative Methods; Randomized Clinical Trials; Reach Effectiveness Adoption Implementation and Maintenance; Recommendation; Research Project Grants; Resource-limited setting; Resources; Rwanda; Screening for cancer; Services; Standardization; Symptoms; Tablets; Testing; Time; Time Series Analysis; Training; Training Programs; United States; Ursidae Family; Visit; Woman; Work; World Health Organization; acceptability and feasibility; advanced breast cancer; base; breast cancer diagnosis; breast cancer survival; cancer diagnosis; cancer therapy; contextual factors; early phase clinical trial; evidence base; follow-up; global health; implementation evaluation; implementation fidelity; implementation research; implementation science; implementation strategy; interest; low and middle-income countries; malignant breast neoplasm; mortality; older women; preventable death; primary care services; primary care setting; programs; scale up; service delivery; success; sustainability framework

PROJECT SUMMARY The burden of breast cancer is rising rapidly in low- and middle-income countries (LMICs), where most women with breast cancer are diagnosed with advanced-stage disease. Largely because of late-stage presentations, despite lower age-standardized incidence of breast cancer in sub-Saharan Africa, the region’s breast cancer mortality rates are higher than the United States’. We previously studied an intervention to facilitate timely evaluation of breast symptoms in a single Rwandan district (Burera District) which increased the number of women receiving evaluation for breast symptoms and increased early-stage diagnoses. However, effective strategies to scale-up breast cancer early diagnosis programs in resource-constrained primary health care systems are not well-understood. Particular challenges for scaling early diagnosis include integration of clinical breast assessment with other primary care services and facilitating timely, reliable linkage of patients with concerning breast findings to higher levels of care. The objective of this research project is to study implementation successes and challenges of Rwanda Biomedical Centre’s (RBC’s) scale-up of the Burera intervention to other districts. To facilitate scaleup, RBC has adapted the program to integrate breast cancer awareness-raising and evaluation of symptomatic women into a cervical cancer screening initiative and is utilizing a tablet-based electronic medical record to facilitate patient tracking. This project will evaluate implementation of this adapted scaleup initiative, and facilitators of and barriers to successful implementation. In Aim 1 we will use the RE-AIM framework to retrospectively examine the WCEDP’s reach, effectiveness, adoption and facilities’ implementation fidelity over the program’s first year. In Aim 2, we will use qualitative methods guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify health workers’ perceptions of fit, feasibility and acceptability of the WCEDP and inner and outer context factors influencing success. We will also interview women diagnosed with breast cancer through the WCEDP to explore fit, acceptability, and participation barriers and facilitators. Understanding the implementation successes and challenges of this adapted model will inform further adaptations that can be studied in a larger research project and linked to longer-term outcomes. This project aligns with the National Cancer Institute’s special interest in implementation research related to cancer control in LMICs and its commitment to pursuing equity in global cancer control.

项目摘要 在低收入和中等收入国家（LMIC）的乳腺癌的燃烧迅速增加，大多数女性 乳腺癌被诊断出患有晚期疾病。很大程度上是由于后期演讲， 尽管撒哈拉以南非洲的乳腺癌年龄标准化的发生率较低，但该地区的乳腺癌 死亡率高于美国。我们以前研究了一种干预措施，以促进及时 评估单个卢旺达地区（Burera区）的乳房症状，该地区增加了 接受评估乳房症状并增加早期诊断的妇女。但是，有效 扩展乳腺癌早期诊断计划的策略 护理系统不是很好的理解。扩展早期诊断的特殊挑战包括集成 与其他初级保健服务的临床乳房评估，并支持患者的及时，可靠的联系 关于乳房的发现至较高的护理水平。该研究项目的目的是研究 卢旺达生物医学中心（RBC）的实施成功和挑战的Burera规模 干预其他地区。为了促进缩放量，RBC改编了该计划以整合乳腺癌 提高症状女性的意识提高和评估宫颈癌筛查计划，是 使用基于平板电脑的电子病历来促进患者跟踪。这个项目将评估 实施这项改编的规模倡议，以及成功实施的障碍的促进者和障碍。 在AIM 1中，我们将使用RE-AIM框架回顾性地检查WCEDP的影响力，有效性， 收养和设施的实施忠诚度比该计划的第一年。在AIM 2中，我们将使用定性 以探索，准备，实施，维持（EPIS）框架为指导的方法 卫生工作者对WCEDP以及内部和外部环境的适应性，可行性和可接受性的看法 因素影响成功。我们还将通过WCEDP采访被诊断为乳腺癌的妇女 探索合适，可接受性和参与障碍和促进者。了解实施 这种改编的模型的成功和挑战将为您提供进一步的改编，可以在更大的 研究项目，与长期结局有关。该项目与国家癌症保持一致 研究所对LMIC及其癌症控制有关的实施研究的特殊兴趣及 致力于追求全球癌症控制权的公平。