Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Cancer. 2013 Aug 1;119 Suppl 15(Suppl 15):2870-83. doi: 10.1002/cncr.28162.
Colorectal cancer, as the second leading cause of cancer-related deaths among men and women in the United States, represents an important area for public health intervention. Although colorectal cancer screening can prevent cancer and detect disease early when treatment is most effective, few organized public health screening programs have been implemented and evaluated. From 2005 to 2009, the Centers for Disease Control and Prevention funded 5 sites to participate in the Colorectal Cancer Screening Demonstration Program (CRCSDP), which was designed to reach medically underserved populations.
The authors conducted a longitudinal, multiple case study to analyze program implementation processes. Qualitative methods included interviews with 100 stakeholders, 125 observations, and review of 19 documents. Data were analyzed within and across cases.
Several themes related to CRCSDP implementation emerged from the cross-case analysis: the complexity of colorectal cancer screening, the need for teamwork and collaboration, integration of the program into existing systems, the ability of programs to use wisdom at the local level, and the influence of social norms. Although these themes were explored independently from 1 another, interaction across themes was evident.
Colorectal cancer screening is clinically complex, and its screening methods are not well accepted by the general public; both of these circumstances have implications for program implementation. Using patient navigation, engaging in transdisciplinary teamwork, assimilating new programs into existing clinical settings, and deferring to local-level wisdom together helped to address complexity and enhance program implementation. In addition, public health efforts must confront negative social norms around colorectal cancer screening.
在美国，结直肠癌是男性和女性癌症相关死亡的第二大主要原因，是公共卫生干预的重要领域。虽然结直肠癌筛查可以预防癌症，并在治疗最有效的时候及早发现疾病，但很少有有组织的公共卫生筛查计划得到实施和评估。从 2005 年到 2009 年，疾病控制与预防中心资助了 5 个地点参与结直肠癌筛查示范计划（CRCSDP），旨在覆盖医疗服务不足的人群。
作者进行了一项纵向、多案例研究，以分析计划实施过程。定性方法包括对 100 名利益相关者进行访谈、125 次观察以及对 19 份文件的审查。在案例内和跨案例进行数据分析。
跨案例分析中出现了与 CRCSDP 实施相关的几个主题：结直肠癌筛查的复杂性、团队合作与协作的必要性、将项目纳入现有系统、项目利用地方智慧的能力，以及社会规范的影响。虽然这些主题是相互独立地进行探讨的，但主题之间的相互作用是明显的。
结直肠癌筛查在临床上较为复杂，其筛查方法也未被公众广泛接受；这两种情况都对项目实施产生影响。通过使用患者导航、开展跨学科团队合作、将新项目融入现有临床环境以及依靠地方层面的智慧，有助于应对复杂性并加强项目实施。此外，公共卫生工作必须应对结直肠癌筛查方面的负面社会规范。
