Dickerson Lindsay K, Rositch Anne F, Lucas Susan, Harvey Susan C
, Johns Hopkins University School of Medicine; , Johns Hopkins Bloomberg School of Public Health; , Johns Hopkins Medical Institutions, Baltimore, MD; and , Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa.
J Glob Oncol. 2017 Mar 27;3(5):502-508. doi: 10.1200/JGO.2016.008086. eCollection 2017 Oct.
Breast cancer is the leading cause of cancer death in women worldwide, with high mortality in low- and middle-income countries because of a lack of detection, diagnosis, and treatment. With mammography unavailable, ultrasound offers an alternative for downstaging. The literature reports successful training in various domains, but a focus on the breast is novel. We assessed the feasibility (knowledge acquisition, perceived usefulness, and self-efficacy) of breast ultrasound training for nonphysician providers.
Training was implemented for 12 providers at Hlokomela Clinic in Hoedspruit, South Africa, over 3 weeks. Didactic presentations and example cases were followed by a presurvey and test (n = 12). All providers received hands-on training with nurses as models; five providers trained with patients. A post-test (n = 12) assessed knowledge acquisition and a postsurvey (n = 10) assessed perceived program usefulness and provider self-efficacy.
The pre- to post-test averages improved by 68% in total and in four competencies (foundational knowledge, descriptive categories, benign malignant, and lesion identification). On the postsurvey, providers expressed that ultrasound could significantly influence breast cancer detection (9.1 out of 10), treatment (7.9 out of 10), and survival (8.7 out of 10) in their community and endorsed moderate confidence in their scanning (6.3 out of 10) and interpreting abilities (5.6 out of 10).
Our research supports the feasibility of breast ultrasound training as part of a breast education program in low- and middle-income countries. Pre- and post-test results and observed proficiency indicate that training nonphysician providers is achievable; postsurvey responses indicate program acceptance, community-based ownership, and provider self-efficacy with ultrasound. Future work may show that breast ultrasound is viable for early detection where mammography is unavailable.
乳腺癌是全球女性癌症死亡的主要原因，在低收入和中等收入国家，由于缺乏检测、诊断和治疗，死亡率很高。在无法进行乳房X光检查的情况下，超声检查为降低分期提供了一种替代方法。文献报道了在各个领域的成功培训，但专注于乳房检查是新颖的。我们评估了针对非医生提供者进行乳房超声培训的可行性（知识获取、感知有用性和自我效能感）。
在南非霍德斯普鲁特的Hlokomela诊所，对12名提供者进行了为期3周的培训。在进行理论讲座和示例病例讲解后，进行了预调查和测试（n = 12）。所有提供者都以护士为模型接受了实践培训；五名提供者对患者进行了培训。后测（n = 12）评估知识获取情况，后调查（n = 10）评估对项目有用性的感知和提供者的自我效能感。
从测试前到测试后，总分以及四个能力方面（基础知识、描述性类别、良性与恶性以及病变识别）的平均分提高了68%。在后调查中，提供者表示超声检查对其所在社区的乳腺癌检测（9.1分，满分10分）、治疗（7.9分，满分10分）和生存（8.7分，满分10分）有显著影响，并对自己的扫描能力（6.3分，满分10分）和解读能力（5.6分，满分10分）表示有中等程度的信心。
我们的研究支持在低收入和中等收入国家将乳房超声培训作为乳房教育项目一部分的可行性。测试前和测试后的结果以及观察到的熟练程度表明，培训非医生提供者是可行的；后调查的反馈表明该项目得到认可、具有社区基础以及提供者对超声检查的自我效能感。未来的工作可能会表明，在无法进行乳房X光检查的情况下，乳房超声检查对于早期检测是可行的。
