Evaluating scaleup of an adapted breast cancer early diagnosis program in Rwanda

评估卢旺达适应性乳腺癌早期诊断计划的扩大规模

• 批准号: 10588139
• 负责人: Lydia Pace
• 金额: $ 20.37万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-08 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10588139
• 关键词: Adoption; Africa South of the Sahara; Age; Agreement; Area; Awareness; Breast; Breast Cancer Early Detection; Bundling; Cancer Control; Caring; Cervical Cancer Screening; Cessation of life; Clinic; Clinical; Communities; Community Health Aides; Community Outreach; Community Services; Computerized Medical Record; Controlled Study; Country; Diagnosis; Diagnostic; Diagnostic Services; Disease; District Hospitals; Early Diagnosis; Effectiveness; Equity; Evaluation; Exploration, Preparation, Implementation, and Sustainment; Health; Healthcare; Healthcare Systems; Hospitals; Hybrids; Incidence; Income; Interruption; Intervention; Intervention Studies; Interview; Link; Literature; Malignant Neoplasms; Modeling; National Cancer Institute; Outcome; Patients; Perception; Policies; Primary Care; Primary Health Care; Program Effectiveness; Program Sustainability; Provider; Qualitative Methods; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research Project Grants; Resource-limited setting; Resources; Rwanda; Screening for cancer; Services; Standardization; Symptoms; Tablets; Testing; Time Series Analysis; Training; Training Programs; United States; Visit; Woman; Work; World Health Organization; acceptability and feasibility; advanced breast cancer; breast cancer diagnosis; breast cancer survival; cancer diagnosis; cancer therapy; contextual factors; early phase clinical trial; evidence base; follow-up; global health; implementation evaluation; implementation fidelity; implementation research; implementation science; implementation strategy; interest; low and middle-income countries; malignant breast neoplasm; mortality; older women; preventable death; primary care services; primary care setting; primary health center; programs; randomized, clinical trials; scale up; service delivery; success

PROJECT SUMMARY The burden of breast cancer is rising rapidly in low- and middle-income countries (LMICs), where most women with breast cancer are diagnosed with advanced-stage disease. Largely because of late-stage presentations, despite lower age-standardized incidence of breast cancer in sub-Saharan Africa, the region’s breast cancer mortality rates are higher than the United States’. We previously studied an intervention to facilitate timely evaluation of breast symptoms in a single Rwandan district (Burera District) which increased the number of women receiving evaluation for breast symptoms and increased early-stage diagnoses. However, effective strategies to scale-up breast cancer early diagnosis programs in resource-constrained primary health care systems are not well-understood. Particular challenges for scaling early diagnosis include integration of clinical breast assessment with other primary care services and facilitating timely, reliable linkage of patients with concerning breast findings to higher levels of care. The objective of this research project is to study implementation successes and challenges of Rwanda Biomedical Centre’s (RBC’s) scale-up of the Burera intervention to other districts. To facilitate scaleup, RBC has adapted the program to integrate breast cancer awareness-raising and evaluation of symptomatic women into a cervical cancer screening initiative and is utilizing a tablet-based electronic medical record to facilitate patient tracking. This project will evaluate implementation of this adapted scaleup initiative, and facilitators of and barriers to successful implementation. In Aim 1 we will use the RE-AIM framework to retrospectively examine the WCEDP’s reach, effectiveness, adoption and facilities’ implementation fidelity over the program’s first year. In Aim 2, we will use qualitative methods guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify health workers’ perceptions of fit, feasibility and acceptability of the WCEDP and inner and outer context factors influencing success. We will also interview women diagnosed with breast cancer through the WCEDP to explore fit, acceptability, and participation barriers and facilitators. Understanding the implementation successes and challenges of this adapted model will inform further adaptations that can be studied in a larger research project and linked to longer-term outcomes. This project aligns with the National Cancer Institute’s special interest in implementation research related to cancer control in LMICs and its commitment to pursuing equity in global cancer control.

项目总结 在低收入和中等收入国家，乳腺癌的负担正在迅速上升，在这些国家，大多数女性 患有乳腺癌的人被诊断为晚期疾病。这在很大程度上是因为后期演示， 尽管撒哈拉以南非洲的乳腺癌年龄标化发病率较低，但该地区的乳腺癌 死亡率高于美国。我们之前研究了一种干预措施，以便于及时 对单一卢旺达区(Burera区)乳房症状的评估增加了乳房症状的数量 接受乳房症状评估并增加早期诊断的妇女。然而，有效的 在资源有限的初级卫生保健中扩大乳腺癌早期诊断项目的策略 护理系统还没有被很好地理解。扩展早期诊断的特殊挑战包括集成 临床乳房评估与其他初级保健服务相结合，促进患者及时、可靠地联系 有关乳房发现的问题需要更高级别的护理。这项研究项目的目的是研究 卢旺达生物医学中心(RBC)扩大Burera的实施成功和挑战 对其他地区的干预。为了便于扩大规模，RBC已经对该计划进行了调整，以整合乳腺癌 将提高认识和对有症状妇女的评估纳入宫颈癌筛查倡议，并正在 利用基于平板的电子病历来促进患者跟踪。该项目将评估 这一调整后的扩大举措的实施，以及成功实施的促进者和障碍。 在目标1中，我们将使用RE-AIM框架来回顾WCEDP的覆盖范围、有效性、 在该计划的第一年，采用和设施实施的保真度。在目标2中，我们将使用定性 以探索、准备、实施、可持续(EPIS)框架为指导的方法 医务人员对WCEDP的适合性、可行性和可接受性及内外环境的认知 影响成功的因素。我们还将通过WCEDP采访被诊断为乳腺癌的妇女 探索适合性、可接受性、参与障碍和促进者。了解实施情况 这种适应模式的成功和挑战将为进一步的适应提供信息，这些适应可以在更大的范围内进行研究 研究项目，并与更长期的成果挂钩。该项目与美国国家癌症研究所合作 研究所对与低收入国家和低收入国家癌症控制相关的实施研究特别感兴趣 致力于在全球癌症控制中追求公平。