A study of the implementation of population-based bowel cancer screening in Malaysia

点击翻译按钮获取中文摘要

Colorectal Cancer (CRC) is the second most common cancer in Malaysia and CRC-related deaths are predicted to increase from 2,565 in 2015 to 4,562 in 2030. CRC-related deaths may be avoided by early presentation, detection and appropriate treatment. However, cancers in Malaysia present at late stages. The Ministry of Health recommends annual screening for Malaysians aged 50 years or above to diagnose CRC early and increase chances of survival. However, research indicates that over 90% of the Malaysia population in that age group do not follow these recommendations. Recently, our research group conducted a population representative survey of 953 adults and found that they reported that they did not know 'how to go about screening' and that they believed that they were 'not the right age to undergo routine CRC screening'. There is a need to design and develop or adapt a programme that will ensure that Malaysians will avail of CRC screening. In order to support earlier presentation and diagnosis and to improve survival rates, the "Bowel Cancer Screening Programme" (BCSP) was launched in England in 2006 and, more recently in 2010, a BCSP was designed and implemented by Northern Ireland's Public Health Agency. Evaluation findings reported an increased screening uptake of CRC as well as a shift towards earlier stage disease. There is a clear need for a co-ordinated, population-based CRC screening programme in Malaysia. Previous population-based surveys indicate that particular attention should be paid towards targeting common cancer disparities among various ethnic, socio-economic and geographical groups in Malaysia. The main aim of the proposed project is to address the need to design and develop a programme that is theoretically informed, evidence-based and culturally appropriate for Malaysia by building upon the BCSP programmes in NI and England, and then to evaluate the feasibility and acceptability of the programme.The project comprises four phases. Phase 1 will review and synthesise the evidence and experiential learning regarding the lessons about implementation of CRC screening in NI and elsewhere; and will assess the views and preferences of key stakeholder groups particularly the views of the general population regarding CRC screening, how to facilitate easy access to screening and views about a population-based CRC Intervention in Malaysia (CRC-SIM). Phase 2 will involve further partnership working and the co-design of a culturally sensitive population-based CRC screening programme and the identification and agreement of metrics for the evaluation of implementation in Malaysia. Previous learning and perspectives will be presented and discussed in order to finalise the design and evaluation framework for the appraisal of the CRC-SIM and the assessment tools in the context of the Malaysian infrastructure and health system. Phase 3 will involve conducting a study of the implementation of population-based CRC screening in a selected district in order to test appropriateness, feasibility and acceptability. We will run the CRC-SIM in the study district and evaluate its implementation and acceptability using process measures and surveys of participants. Phase 4 will develop a working (logic) model of CRC-SIM based on the findings from the previous phases and the results of an initial economic appraisal as well as developing a protocol for a pilot evaluation of the implementation model in order to inform a national scaled-up programme including planning requirements, resources and costs.