Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process.
Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process.
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DOI：
10.1200/go.20.00186
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发表时间：
2020-09
影响因子：
4.5
通讯作者：
Keating NL
中科院分区：
文献类型：
--
作者：
Pace LE;Schleimer LE;Shyirambere C;Ilbawi A;Dusengimana JMV;Bigirimana JB;Uwizeye FR;Chamberlin M;Lee YS;Shulman LN;Troyan S;Anderson BO;Duggan C;O'Neil DS;Dvaladze A;Brock J;Nguyen C;Ruhangaza D;Habimana O;Nsabimana N;Butonzi J;Nkusi E;Mpunga T;Keating NL
癌症的负担在低收入和中等收入国家（LMIC），包括撒哈拉以南非洲地区正在增加。确保在这些地区提供高质量的癌症护理是一个紧迫的问题。有必要制定战略，以确定有意义和相关的质量措施，这些措施适用于并可用于资源有限环境中的质量衡量和改进。为了确定卢旺达Butaro癌症卓越中心（BCCOE）乳腺癌护理的质量措施，我们使用了一种改进的德尔菲方法，该方法由两个专家小组组成，一个专家小组具有乳腺癌证据和高收入国家使用的措施的专业知识，另一个专家小组具有卢旺达癌症护理提供的专业知识。我们对文献的系统回顾没有发现描述低收入国家开发的乳腺癌质量指标的出版物，但它确实提供了40种质量指标，我们根据我们的环境进行了调整。经过两次调查、一次电话会议和一次面对面会议，确定了17项与病理学、分期和治疗计划、手术、化疗、内分泌治疗、姑息治疗和保留护理相关的措施。这一进程取得的成功包括各种各样的全球专家的参与，以及东加勒比商业理事会社区参与质量衡量和改进。预期的挑战包括，随着卢旺达资源、协议和测量能力的迅速发展，需要不断完善这些措施。一个由全球和当地专家参与的经修改的德尔菲进程是一个有希望的战略，可用于确定卢旺达乳腺癌的质量措施。该过程和由此产生的措施也可能与其他LMIC癌症设施有关。接下来的步骤包括在乳腺癌患者的回顾性队列中验证这些措施。
The burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings. To identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda. Our systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda. A modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.