Interventions to increase adherence to cervical cancer early detection and treatment recommendations in Mexico City clinics

墨西哥城诊所采取干预措施，提高对宫颈癌早期检测和治疗建议的遵守率

• 批准号: 10528196
• 负责人: DONNA L SPIEGELMAN
• 金额: $ 34.14万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10528196
• 关键词: Address; Adherence; Administrator; Biometry; Cancer Control; Cancer Detection; Cancer Etiology; Cancerous; Caring; Cervical; Cervical Cancer Screening; Chronic Disease; Cities; Clinic; Clinical; Clinical Practice Guideline; Colposcopy; Consolidated Framework for Implementation Research; Country; Data; Data Collection; Detection; Diagnosis; Diagnostic; Early Diagnosis; Early treatment; Education; Evaluation; Feedback; Future; Goals; Guideline Adherence; Guidelines; Health Personnel; Healthcare Systems; Hispanic; Incidence; Income; Information Systems; Intervention; Latin America; Lesion; Logic; Malignant neoplasm of cervix uteri; Methods; Mexican; Mexico; Modeling; Not Hispanic or Latino; Outcome; Patients; Primary Prevention; Process; Protocols documentation; Provider; Recommendation; Research; Resource-limited setting; Resources; Secondary Cancer Prevention; Self Management; System; Testing; Time; Woman; World Health Organization; adherence rate; base; cancer care; cancer health disparity; cancer prevention; cancer therapy; cervical cancer prevention; clinical decision support; design; dissemination science; evidence base; follow-up; health belief; health care service organization; implementation determinants; implementation outcomes; implementation science; implementation strategy; implementation study; implementation trial; improved; interest; low and middle-income countries; mortality; premalignant; programs; response; scale up; screening; screening guidelines; success; treatment guidelines; treatment program

Project summary/Abstract Despite being highly preventable, stark cervical cancer (CC) disparities exist globally. CC is the second leading cause of cancer mortality among Mexican women, where CC detection, diagnosis, and treatment delays result from suboptimal implementation of and adherence to longstanding Mexican early detection, diagnosis, and treatment guidelines, which have been in existence since 1974. In contrast, CC is the 12th leading cause of cancer mortality among women in the US, where evidence about patient, provider, and health care organizational factors associated with adherence to CC early detection and diagnosis recommendations likely associated with the success of CC control programs has accrued. In Mexico, screening rates are suboptimal (50-67%), in contrast to 80% in the US, and follow-up colposcopy among Mexican women with abnormal screens is 43%, in contrast to around 66%-71% in the US. In response to NOT-CA-20-025 Notice of Special Interest (NOSI): Dissemination and Implementation Science for Cancer Prevention and Control in Low Resource Environments, we propose to identify barriers to and facilitators of adherence to the Mexican guidelines for follow-up from an abnormal screen onward down the CC care cascade (MGMACS, Mexican Guidelines for Managing Abnormal Cervical Cancer Screening Tests), and to develop strategies to increase adherence to these guidelines in clinics in Tlalpan, a Southern district of Mexico City. Following an Implementation Mapping approach, guided by the Consolidated Framework for Implementation Research (CFIR), the Health Belief Model, and the Implementation Outcomes Framework (IOF), we will evaluate the determinants of implementation and outcomes of the current MGMACS implementation and develop a logic model describing the process for improving adherence to the MGMACS from abnormal screens onwards down the cascade, among patients, providers, and clinics (Aim 1). Next, we will select and adapt implementation strategies that address the barriers identified to improve adherence to MGMACS (Aim 2). In both aims, we will use qualitative and quantitative methods for data collection and synthesis of findings, embedding them together in a multistage integrated convergent mixed methods design and analysis approach. Our study team has extensive research expertise in biostatistics, implementation science methods and practice, and CC prevention and control in Mexico and elsewhere. We aim to gather data to inform a future external application for a large-scale implementation study on improving adherence to MGMACS. This project will provide a model for an implementation science-based approach to improving CC early detection, diagnosis, and treatment programs in similar under-resourced contexts in Latin America and beyond, contributing to the reduction and ultimate elimination of CC.

项目摘要/摘要 尽管是高度可预防的，但全球范围内存在着明显的宫颈癌(CC)差异。CC是第二大领头羊 墨西哥妇女癌症死亡原因，导致CC检测、诊断和治疗延误 从次优的实施和坚持到墨西哥长期存在的早期检测、诊断和 自1974年以来一直存在的治疗指南。相比之下，CC是12个主要原因 美国女性癌症死亡率，关于患者、提供者和医疗保健的证据 与遵守CC早期检测和诊断建议相关的组织因素可能 与CC控制程序的成功相关的信息已经积累起来。在墨西哥，筛查率处于次优水平 (50%-67%)，而在美国为80%，并对患有异常的墨西哥妇女进行阴道镜随访 屏幕的比例为43%，而美国的比例约为66%-71%。回应NOT-CA-20-025特别通知 兴趣(NOSI)：低地癌症预防和控制的传播和实施科学 资源环境，我们建议找出遵守墨西哥法律的障碍和促进者 从异常筛查开始向下进行CC护理级联的随访指南(MGMACS，墨西哥 管理异常宫颈癌筛查测试的指南)，并制定战略，以增加 墨西哥城南区特拉尔潘的诊所遵守这些指导方针。在此之后 实施研究综合框架指导下的实施映射方法 (CFIR)、健康信念模式和实施成果框架(IOF)，我们将评估 当前MGMACS实施的决定因素和结果，并制定一种逻辑 描述从异常屏幕向下改进对MGMACS的依附性的过程的模型 患者、提供者和诊所之间的级联(目标1)。接下来，我们将选择和调整实施 应对为提高遵守MGMACS而确定的障碍的战略(目标2)。在这两个目标中，我们将 使用定性和定量方法收集数据和综合调查结果，并将其嵌入 提出了一种多阶段融合融合的混合方法设计与分析方法。我们的学习团队 在生物统计学、实施科学方法和实践以及CC方面拥有广泛的研究专长 墨西哥和其他地方的预防和控制。我们的目标是收集数据，为未来的外部应用程序提供信息 进行大规模实施研究，以提高对MGMACS的遵从性。该项目将提供一个模型 用于实施以科学为基础的方法来改进CC的早期发现、诊断和治疗 在拉丁美洲和其他地区类似资源不足的情况下的方案，有助于减少和 最终淘汰CC。

项目成果

Factors associated with receiving results and attending colposcopy in patients with positive HPV screens in Mexico City.

• DOI: 10.1016/j.pmedr.2023.102347
• 发表时间: 2023-10
• 期刊: PREVENTIVE MEDICINE REPORTS
• 影响因子: 2.8
• 作者: Leon-Maldonado, Leith;Hernandez-Ramirez, Raul U.;Torres-Ibarra, Leticia;Spiegelman, Donna;Sheth, Sangini S.;Lazcano, Eduardo;Cadena-Fiscal, Jose D.;Salmeron, Jorge
• 通讯作者: Salmeron, Jorge