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

结直肠癌（CRC）是马来西亚第二大常见癌症，预计CRC相关死亡人数将从2015年的2，565人增加到2030年的4，562人。通过早期发现、早期诊断和适当治疗，可以避免CRC相关死亡。然而，马来西亚的癌症处于晚期阶段。卫生部建议每年为50岁或以上的马来西亚人进行筛查，以早期诊断CRC并增加生存机会。然而，研究表明，该年龄组的马来西亚人口中有90%以上没有遵守这些建议。最近，我们的研究小组对953名成年人进行了一项人口代表性调查，发现他们报告说，他们不知道“如何进行筛查”，他们认为自己“不是进行常规CRC筛查的合适年龄”。有必要设计和制定或调整一项方案，以确保马来西亚人能够利用CRC筛查。为了支持早期表现和诊断并提高存活率，2006年在英格兰启动了“肠癌筛查方案”，最近在2010年，北方爱尔兰公共卫生署设计并实施了肠癌筛查方案。评估结果报告了CRC的筛查摄取增加以及向早期疾病的转变。马来西亚显然需要一个协调的、以人口为基础的CRC筛查计划。以前的人口调查表明，应特别注意针对马来西亚各族裔、社会经济和地理群体之间的常见癌症差异。拟议项目的主要目的是通过在北爱尔兰和英国的BCSP方案的基础上，满足设计和制定一个理论上知情、以证据为基础和文化上适合马来西亚的方案的需要，然后评估该方案的可行性和可接受性。第一阶段将审查和综合有关在北爱尔兰和其他地方实施CRC筛查的经验教训的证据和经验教训;并将评估主要利益相关者群体的意见和偏好，特别是一般人群对CRC筛查的意见，如何方便筛查以及对马来西亚基于人口的CRC干预措施（CRC-SIM）的意见。第二阶段将涉及进一步的伙伴关系工作和共同设计一个文化敏感的基于人口的CRC筛查方案，并确定和商定评估马来西亚实施情况的指标。将介绍和讨论以前的学习和观点，以最终确定CRC-SIM评估的设计和评估框架以及马来西亚基础设施和卫生系统背景下的评估工具。第三阶段将包括在选定的地区进行一项以人口为基础的CRC筛查的研究，以测试其适当性、可行性和可接受性。我们将在研究区开展CRC-SIM，并使用过程措施和参与者调查评估其实施情况和可接受性。第四阶段将根据前几个阶段的调查结果和初步经济评估的结果，制定CRC-SIM的工作（逻辑）模型，并制定实施模型试点评估协议，以便为国家扩大方案提供信息，包括规划要求、资源和成本。

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.