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

基本信息

批准号：
10588139
负责人：
Lydia Pace
金额：
$ 20.37万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-08 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10588139
关键词：
Adoption Africa South of the Sahara Age Agreement 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 Community Services Computerized Medical Record Controlled Study Country Diagnosis Diagnostic Diagnostic Services Disease District Hospitals Early Diagnosis Effectiveness Equity 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 Care Primary Health Care Program Effectiveness Program Sustainability Provider Qualitative Methods Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Project Grants Resource-limited setting Resources Rwanda Screening for cancer Services Standardization Symptoms Tablets Testing Time Series Analysis Training Training Programs United States Visit Woman Work World Health Organization acceptability and feasibility advanced breast cancer 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 primary health center programs randomized, clinical trials scale up service delivery success

项目摘要

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.

项目概要在低收入和中等收入国家 (LMIC)，乳腺癌的负担正在迅速上升，其中大多数女性患有乳腺癌的人被诊断为晚期疾病，很大程度上是因为已处于晚期。尽管撒哈拉以南非洲地区乳腺癌的年龄标准化发病率较低，但该地区的乳腺癌发病率我们之前研究了一种促进及时干预的干预措施。对卢旺达单个地区（布雷拉区）的乳房症状进行评估，增加了接受乳房症状评估并增加早期诊断的女性是有效的。在资源有限的初级卫生保健中扩大乳腺癌早期诊断计划的策略扩大早期诊断的具体挑战包括整合护理系统。与其他初级保健服务进行临床乳房评估，并促进患者及时、可靠的联系该研究项目的目的是研究有关乳房发现的更高水平的护理。卢旺达生物医学中心 (RBC) 扩大 Burera 的实施成功与挑战为了扩大干预范围，RBC 已调整该计划以整合乳腺癌。提高对有症状的妇女进行宫颈癌筛查和评估的认识和举措该项目将评估利用基于平板电脑的电子病历来促进患者追踪。这一经过调整的扩大规模举措的实施，以及成功实施的促进因素和障碍。在目标 1 中，我们将使用 RE-AIM 框架回顾性地检查 WCEDP 的范围、有效性、计划第一年的采用率和设施的保真度在目标 2 中，我们将采用定性实施。以探索、准备、实施、维持 (EPIS) 框架为指导的方法来确定卫生工作者对 WCEDP 以及内部和外部背景的适合性、可行性和可接受性的看法我们还将采访通过 WCEDP 诊断出患有乳腺癌的女性。探索适合性、可接受性和参与障碍和促进因素。这种适应模型的成功和挑战将进一步为可以在更大范围内研究的适应提供信息研究项目并与长期成果相关。该项目与国家癌症项目一致。研究所对中低收入国家及其地区癌症控制相关的实施研究特别感兴趣致力于追求全球癌症控制的公平性。