Lofters A K, Vahabi M, Prakash V, Banerjee L, Bansal P, Goel S, Dunn S
Department of Family and Community Medicine; Dalla Lana School of Public Health, University of Toronto; Department of Family and Community Medicine; Centre for Urban Health Solutions, St Michael's Hospital.
Daphne Cockwell School of Nursing, Ryerson University, Toronto.
Patient Prefer Adherence. 2017 Mar 8;11:495-503. doi: 10.2147/PPA.S127147. eCollection 2017.
Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach.
Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months.
Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer) to 44.6% (breast cancer) of patients came in for screening within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties.
Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numerous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as explore how to provide infrastructure for lay health educator training and time.
安大略省的南亚居民参与癌症筛查的比例较低。这项试点研究的目的是确定在初级保健提供者的诊疗工作中配备非专业健康教育工作者，采用质量改进方法，是否能够提高南亚患者进行筛查的意愿以及癌症筛查的参与率。
参与研究的医生选择他们认为能够提高筛查意愿和癌症筛查参与率的质量改进措施，在其办公室实施，必要时进行调整，为期六个月。
四名初级保健医生参与了该研究。他们估计自己至少60%的患者为南亚裔。所有医生都选择与一个现有的面向南亚人的非专业健康教育工作者项目合作。健康大使在办公室与患者交谈并给患者打电话。对于所有医生来说，约60%逾期未进行癌症筛查且直接与健康大使交谈过的南亚患者表示愿意接受筛查。一名医生能够追踪被联系患者的实际筛查情况，发现筛查参与率相对较高：在首次电话联系后的六个月内，前来筛查的患者比例从29.2%（结直肠癌）到44.6%（乳腺癌）不等。尽管医生对健康大使评价积极，但他们发现该研究耗时且资源密集，尤其是这项工作是在日常临床职责之外额外进行的。
在初级保健诊疗工作中配备南亚非专业健康教育工作者，用患者自己的语言给他们打电话，在本研究中显示出有望提高对筛查意愿和癌症筛查参与率的认识，但也耗时且资源密集，面临诸多挑战。未来的质量改进工作应进一步完善电话邀请流程，并探索如何为非专业健康教育工作者的培训和时间提供支持。
