Improving Adherence to Breast Cancer Treatment Guidelines in Nigeria

项目概要/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。 生存率很低，部分原因是无法获得有效的治疗。国家综合癌症 网络 (NCCN) 制定了撒哈拉以南非洲 (SSA) 协调准则，以促进提供 基于证据、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 在尼日利亚，遵守纪律、符合指南的乳腺癌护理与改善预后相关。 尽管如此，指南的实施和遵守情况仍是零星的，并且尚未得到系统评估。 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研究者 在全球肿瘤学领域，重点关注在资源领域加强循证乳腺癌护理服务的战略 有限的设置。本研究旨在制定和评估提高医疗保健提供者依从性的策略 尼日利亚乳腺癌护理临床实践指南。候选人：罗曼诺夫医生是一名乳腺外科医师 西奈山伊坎医学院的肿瘤学家，她是该系的助理教授 全球卫生和卫生系统设计的研究员，以及纪念馆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：1) 卫生服务研究的基础知识，2) 实施科学，以及 3) 全球乳腺肿瘤学。随着 提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者和领导者，并实现她的最终目标 改善全球资源有限地区的乳腺癌预后。研究：本研究将使用 严格的实施科学框架和方法，以加速遵守 NCCN 尼日利亚 SSA 协调准则，最终目标是缩小证据与实践之间的差距 改善基于证据的乳腺癌治疗。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、多层次的 在尼日利亚加强对乳腺癌护理指南的遵守的策略将是可接受的、适当的、 可行且可采用——并有望改变临床实践。研究目的是：1）确定多层次 尼日利亚遵循指南的乳腺癌护理面临的障碍，2) 制定循证实施 提高尼日利亚乳腺癌临床实践指南依从性的策略，以及 3) 严格 评估尼日利亚试点研究中选定的实施策略。该提案的基本原理 实施适合具体情况的策略来促进指南的遵守是否会改善乳房 尼日利亚的癌症护理服务，以及最终患者的生存。

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.