Improving Adherence to Breast Cancer Treatment Guidelines in Nigeria

项目摘要/摘要 背景：乳腺癌是尼日利亚女性癌症发病率和死亡率的最常见原因。 存活率很低，部分原因是获得有效治疗的机会不足。国家综合癌症 制定了撒哈拉以南非洲网络(NCCN)协调准则，以促进交付 以证据为基础，适合具体情况的乳腺癌护理。罗曼诺夫博士之前的工作表明，接收多个 在尼日利亚，纪律、符合指南的乳腺癌护理与改善的结果相关。 尽管如此，指南的执行和遵守是零星的，没有得到系统的评估。 这个K08提案的总体目标是促进罗曼诺夫博士发展成为一名独立的调查员 在全球肿瘤学方面，专注于在以下资源中加强以证据为基础的乳腺癌护理服务的战略- 有限的设置。这项研究旨在开发和评估提高医疗服务提供者忠诚度的策略 尼日利亚乳腺癌护理的临床实践指南。候选人：罗曼诺夫医生是一名乳房外科医生 她是西奈山伊坎医学院的肿瘤学家，系助理教授 全球健康和健康系统设计部主任，以及纪念医院的全球癌症差异研究员 斯隆凯特琳癌症中心(MSK)。候选人发展的目标包括以下方面的教育和培训： 卫生服务研究的基础，2)实施科学，3)全球乳腺肿瘤学。与 拟议的候选人开发和研究活动，罗曼诺夫博士将开发必要的工具 成为全球肿瘤学领域的独立研究员和领导者，并实现她的终极目标 在全球资源有限的情况下改善乳腺癌的预后。研究：这项研究将使用 严格的实施科学框架和方法，以加快遵守NCCN 尼日利亚SSA的统一指导方针，最终目标是减少证据与实践的差距和 改进乳腺癌的循证治疗。为了实现这一目标，罗曼诺夫博士将利用这项研究 非洲肿瘤学研究小组(ARGO)的基础设施，该研究联盟包括MSK和 26个尼日利亚学术机构。总体假设是实施结构化、多层次 尼日利亚加强遵守乳腺癌护理指南的战略将是可接受的、适当的、 可行和可采用--并显示出改变临床实践的前景。研究的目的是：1)识别多层次 尼日利亚符合指南的乳腺癌护理的障碍，2)发展循证实施 提高尼日利亚乳腺癌临床实践指南遵从性的策略，以及3)严格遵守 在尼日利亚的一项试点研究中评估选定的实施战略。这项提议背后的理由是 实施适合具体情况的策略以促进遵守指南将改善乳房 在尼日利亚提供癌症护理服务，最终提高患者的存活率。

PROJECT SUMMARY/ABSTRACT Background: Breast cancer is the most common cause of cancer incidence and mortality in women in Nigeria. Survival is poor, in part due to inadequate access to effective treatment. The National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for sub-Saharan Africa (SSA) were developed to promote delivery of evidence-based, context-appropriate breast cancer care. Dr. Romanoff’s prior work shows that receiving multi- disciplinary, guideline-concordant breast cancer care in Nigeria is associated with improved outcomes. Nonetheless, guideline implementation and adherence are sporadic and have not been systematically evaluated. The overall goal of this K08 proposal is to facilitate Dr. Romanoff’s development into an independent investigator in global oncology, focusing on strategies to enhance evidence-based breast cancer care delivery in resource- limited settings. This research aims to develop and evaluate strategies to improve healthcare provider adherence to clinical practice guidelines for breast cancer care in Nigeria. Candidate: Dr. Romanoff is a Breast Surgical Oncologist at the Icahn School of Medicine at Mount Sinai, where she is an Assistant Professor in the Department of Global Health and Health System Design, as well as a Global Cancer Disparities Researcher at Memorial Sloan Kettering Cancer Center (MSK). Aims for candidate development include education and training in: 1) fundamentals of health services research, 2) implementation science, and 3) global breast oncology. With the candidate development and research activities proposed, Dr. Romanoff will develop the tools necessary to become an independent investigator and leader in the field of global oncology, and meet her ultimate goal of improving breast cancer outcomes in resource-limited settings worldwide. Research: This research will use rigorous implementation science frameworks and methodologies to accelerate adherence to the NCCN Harmonized Guidelines for SSA in Nigeria, with the ultimate goal of reducing the evidence-to-practice gap and improving evidence-based breast cancer treatment. To achieve this, Dr. Romanoff will leverage the research infrastructure of the African Research Group for Oncology (ARGO), a research consortium including MSK and 26 Nigerian academic institutions. The overall hypothesis is that implementation of structured, multi-level strategies to enhance adherence to breast cancer care guidelines in Nigeria will be acceptable, appropriate, feasible and adoptable – and show promise to change clinical practice. Study aims are to: 1) identify multi-level barriers to guideline-concordant breast cancer care in Nigeria, 2) develop evidence-based implementation strategies to improve adherence to breast cancer clinical practice guidelines in Nigeria, and 3) rigorously evaluate selected implementation strategies in a pilot study in Nigeria. The rationale that underlies this proposal is that implementation of context-appropriate strategies to promote guideline adherence will improve breast cancer care delivery in Nigeria, and ultimately patient survival.