A multi-faceted intervention to promote breast cancer hormone receptor testing in Tanzania

项目摘要/摘要 在低收入和中等收入国家(LMIC)，乳腺癌的预后不成比例地差 与高收入国家相比。LMICs中低乳腺癌存活率主要归因于 晚期表现和有限的诊断和治疗能力。虽然国家临床实践 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一需求。病理诊断，包括心率测试， 对于确定癌症的存在、疾病的程度和计划治疗至关重要。然而，人力资源 坦桑尼亚只有两家公立医院提供检测服务。因此，患者的周转时间 几周到几个月，只有一小部分符合条件的妇女接受HR测试和符合指南的治疗。 为了缩小证据与实践之间的差距，我们建议系统地确定最有效的 在坦桑尼亚所有有病理服务的公立转诊医院实施战略，以指导 制定多面性和适应性干预措施(一套实施战略)。我们假设 这项干预措施将增加接受HR测试和指南一致性的女性比例 内分泌治疗，从而改善癌症护理、生活质量和患者的总体短期生存。 首先，我们将进行形成性评估，以确定组织对变革和 确定使用混合方法进行常规人力资源测试的障碍和促进者。然后，我们将确定 针对形成性评价中确定的障碍和促进者的最佳实施战略，以及 以组织理论为指导，开发多元干预方法。最后，我们会 迭代地先导测试多组件干预，并将根据以下条件修改干预组件 结果衡量标准。 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)，有兴趣开发和测试理论驱动的， 多层次的干预措施，以增加低资源环境下基于证据的癌症诊断的整合。 这项研究将在T.Peter Kingham博士(外科医生)的多学科指导下进行 肿瘤学家，全球肿瘤学研究)，杰米·奥斯特罗夫博士(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为癌症护理和健康服务提供出色的环境 研究。为了实现成为一名独立研究人员的目标，吴博士开发了一种结构化的 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。

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.