Beaber Elisabeth F, Kim Jane J, Schapira Marilyn M, Tosteson Anna N A, Zauber Ann G, Geiger Ann M, Kamineni Aruna, Weaver Donald L, Tiro Jasmin A
: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (EFB); Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (JJK); Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA (MMS); Department of Veterans Affairs Medical Center, Philadelphia, PA (MMS); Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH (ANAT); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (AGZ); Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD (AMG); Group Health Research Institute, Seattle, WA (AK); Department of Pathology and University of Vermont Cancer Center, University of Vermont, Burlington, VT (DLW); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (JAT).
J Natl Cancer Inst. 2015 May 7;107(6):djv120. doi: 10.1093/jnci/djv120. Print 2015 Jun.
General frameworks of the cancer screening process are available, but none directly compare the process in detail across different organ sites. This limits the ability of medical and public health professionals to develop and evaluate coordinated screening programs that apply resources and population management strategies available for one cancer site to other sites. We present a trans-organ conceptual model that incorporates a single screening episode for breast, cervical, and colorectal cancers into a unified framework based on clinical guidelines and protocols; the model concepts could be expanded to other organ sites. The model covers four types of care in the screening process: risk assessment, detection, diagnosis, and treatment. Interfaces between different provider teams (eg, primary care and specialty care), including communication and transfer of responsibility, may occur when transitioning between types of care. Our model highlights across each organ site similarities and differences in steps, interfaces, and transitions in the screening process and documents the conclusion of a screening episode. This model was developed within the National Cancer Institute-funded consortium Population-based Research Optimizing Screening through Personalized Regimens (PROSPR). PROSPR aims to optimize the screening process for breast, cervical, and colorectal cancer and includes seven research centers and a statistical coordinating center. Given current health care reform initiatives in the United States, this conceptual model can facilitate the development of comprehensive quality metrics for cancer screening and promote trans-organ comparative cancer screening research. PROSPR findings will support the design of interventions that improve screening outcomes across multiple cancer sites.
癌症筛查过程的总体框架是存在的，但没有一个能直接详细比较不同器官部位的筛查过程。这限制了医学和公共卫生专业人员制定和评估协调筛查计划的能力，这些计划旨在将适用于某一癌症部位的资源和人群管理策略应用于其他部位。我们提出了一个跨器官概念模型，该模型基于临床指南和方案，将乳腺癌、宫颈癌和结直肠癌的单次筛查纳入一个统一框架；该模型的概念可扩展到其他器官部位。该模型涵盖了筛查过程中的四种护理类型：风险评估、检测、诊断和治疗。在不同类型护理之间转换时，不同医疗团队（如初级保健和专科护理）之间可能会出现接口，包括沟通和责任转移。我们的模型突出了每个器官部位在筛查过程中的步骤、接口和转换方面的异同，并记录了一次筛查的结束。该模型是在美国国立癌症研究所资助的“通过个性化方案优化筛查的基于人群的研究”（PROSPR）联盟内开发的。PROSPR旨在优化乳腺癌、宫颈癌和结直肠癌的筛查过程，包括七个研究中心和一个统计协调中心。鉴于美国目前的医疗改革举措，这个概念模型可以促进癌症筛查综合质量指标的制定，并推动跨器官比较癌症筛查研究。PROSPR的研究结果将支持改善多个癌症部位筛查结果的干预措施的设计。
