Promoting Awareness of Cancer and Early Detection (PACED) Initiative in Malaysia

马来西亚的癌症发病率和与癌症有关的死亡人数正在增加。相对较高的癌症死亡率占经医学证实的死亡人数的10%。所有癌症的年龄标准化发病率在男性和女性中分别为每10万人137人和156人。通过早期发现和适当的治疗，可以避免与癌症相关的疾病。然而，马来西亚的癌症出现在晚期。研究清楚地表明，在马来西亚，人们对癌症的认识水平很低，这种认识的低会延误求医的时间，出现的时间很晚，而且诊断率很低。最近，我们的研究小组对1817名成年人进行了一项具有全国代表性的调查，发现了寻求帮助的预期延迟和一些情感障碍。此外，人们对癌症有强烈的误解。例如，超过30%的人不相信癌症可以治愈，令人担忧的是，65%的人认为大多数癌症治疗比癌症本身更糟糕。为了支持早期提出和诊断并提高生存率，2011年在英格兰启动了“明确癌症”方案，最近在2014年，北爱尔兰公共卫生局设计并实施了“了解癌症方案”。评估结果显示，人们对癌症症状和体征的认识有所提高，报告了主要活动相关症状的患者到全科医生诊所就诊的人数也有所增加。此外，更多的人因疑似癌症被全科医生紧急转诊，诊断调查活动有所增加，并且转向早期疾病。马来西亚显然需要一个协调的、大规模的、以人口为基础的提高对癌症认识的规划。我们以人口为基础的调查表明，应特别注意针对马来西亚不同种族、社会经济和地理群体之间常见的癌症差异。拟议项目的主要目的是解决设计和制定一个在理论上知情、以证据为基础、在文化上适合马来西亚的计划或干预措施的需求，然后在BCOC和BeCAP计划的基础上对该计划进行强有力的评估。项目分为四个阶段。第一阶段-“制定具有文化敏感性的提高癌症意识计划”-这一阶段的主要目的是制定提高癌症意识计划的内容，包括主要信息以及实施的设计和测试模式。CARP将重点关注马来西亚最常见的三种癌症——肺癌、乳腺癌和结直肠癌。第二阶段——“设计评估框架”——将举行一次研讨会，讨论并最终确定评估框架和指标，特别是在马来西亚基础设施和卫生系统背景下确定CARP的结果和评估工具。评估框架将以评估BeCAP所使用的方法和方法为依据，并将包括在每次BeCAP活动实施前后进行人口认识调查，以确定认识的变化，包括对癌症和早期诊断的认识、态度、信念和知识。第三阶段，“进行形成性研究”-将采用定性和定量方法测试鲤鱼和评估工具的适当性、可接受性和可行性。第四阶段，“评估CARP的影响”——将在吉隆坡联邦领土和雪兰莪州进行一项大规模的试点评估研究。将开展运动前后的调查，以评估运动的效果，包括对症状和体征的认识、对癌症的信念和态度、早期诊断以及在初级保健医生那里看到运动中突出症状的情况。最后，我们将为推出国家级CARP制定一项协议。

The incidence of cancer in Malaysia and cancer-related deaths are increasing. The relatively high cancer mortality rate accounted for 10% of medically certified deaths. Age-standardized incidence rates for all cancers were 137 and 156 per 100,000 in males and females, respectively. Cancer-related may be avoided by early presentation, detection and appropriate treatment. However, cancers in Malaysia present at late stages. Research indicates clearly that there is a low level of cancer awareness in Malaysia and that low awareness delays help seeking, late presentation is high and detection rates are poor. More recently, our research group conducted a nationally representative survey of 1817 adults and found anticipated delay and several emotional barriers to seeking help. In addition, there were strong misbeliefs about cancer. For example, more than 30% did not belive that cancer could be cured and worryingly, 65% thought that most cancer treatments were worse than cancer itself. In order to support earlier presentation and diagnosis and improve survival rates, the "Be Clear on Cancer" (BCOC) programme was launched in England in 2011 and, more recently in 2014, the "Be Cancer Aware Programme" (BeCAP) was designed and implemented by Northern Ireland's Public Health Agency. Evaluation findings reported an increased awareness about the signs and symptoms of cancer as well as increased attendance at GP practices by patients who reported key campaign-related symptoms. In addition, more people were referred urgently by GPs for suspected cancer, there was an increase in diagnostic investigation activity and there was a shift towards earlier stage disease. There is a clear need for a co-ordinated, large scale population-based cancer awareness raising programme in Malaysia. Our population-based surveys indicate that particular attention should be paid to 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 or intervention that is theoretically informed, evidence-based and culturally appropriate for Malaysia and then to evaluate robustly the programme by building upon the BCOC and BeCAP programmes.The project comprises four phases. Phase 1 - 'Development of a culturally sensitive cancer Awareness Raising Programme (CARP)' - the main aim of this phase is to develop the content of the CARP including the key messages and design and test mode(s) of delivery. The CARP will focus on the three most prevalent cancers in Malaysia - lung, breast and colorectal. Phase 2 - 'Design the evaluation framework', - a workshop will be held to discuss and finalise the evaluation framework and metrics particularly regarding the identification of the outcomes of the CARP and the assessment tools in the context of the Malaysian infrastructure and health system. The evaluation framework will be informed by the approach and methods used in the appraisal of the BeCAP and it will include a population awareness survey before-and-after the implementation of each BeCAP campaign in order to ascertain changes in awareness including recognition, attitudes, beliefs and knowledge about cancer and early diagnosis. Phase 3, 'Undertaking formative research' - qualitative and quantitative methods will be used to test the appropriateness, acceptability and feasibility of the CARP and assessment tools. Phase 4, 'Evaluate the impact of the CARP' - a large scale pilot evaluation study will be conducted in the Federal Territory of Kuala Lumpur and Selangor state. Pre-and post-campaign surveys will be carried out to evaluate the performance of campaign in term of awareness of signs and symptoms, beliefs and attitudes towards cancer and early diagnosis and attendance at primary care physicians with the symptoms highlighted in the campaign. Finally, we will develop a protocol for the roll-out of a national level CARP.