Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Department of Medicine, University of Washington, Seattle, Washington.
Cancer. 2020 May 15;126 Suppl 10(Suppl 10):2339-2352. doi: 10.1002/cncr.32891.
The Breast Health Global Initiative (BHGI) established a series of resource-stratified, evidence-based guidelines to address breast cancer control in the context of available resources. Here, the authors describe methodologies and health system prerequisites to support the translation and implementation of these guidelines into practice.
In October 2018, the BHGI convened the Sixth Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation. The purpose of the summit was to define a stepwise methodology (phased implementation) for guiding the translation of resource-appropriate breast cancer control guidelines into real-world practice. Three expert consensus panels developed stepwise, resource-appropriate recommendations for implementing these guidelines in low-income and middle-income countries as well as underserved communities in high-income countries. Each panel focused on 1 of 3 specific aspects of breast cancer care: 1) early detection, 2) treatment, and 3) health system strengthening.
Key findings from the summit and subsequent article preparation included the identification of phased-implementation prerequisites that were explored during consensus debates. These core issues and concepts are key components for implementing breast health care that consider real-world resource constraints. Communication and engagement across all levels of care is vital to any effectively operating health care system, including effective communication with ministries of health and of finance, to demonstrate needs, outcomes, and cost benefits.
Underserved communities at all economic levels require effective strategies to deploy scarce resources to ensure access to timely, effective, and affordable health care. Systematically strategic approaches translating guidelines into practice are needed to build health system capacity to meet the current and anticipated global breast cancer burden.
乳腺健康全球倡议（BHGI）制定了一系列资源分层、基于证据的指南，以在现有资源的背景下解决乳腺癌控制问题。在这里，作者描述了支持将这些指南转化为实践的方法和卫生系统前提条件。
2018 年 10 月，BHGI 召开了第六届全球提高乳腺保健水平资源分层分阶段实施峰会。峰会的目的是定义一个逐步的方法（分阶段实施），指导将资源适当的乳腺癌控制指南转化为实际实践。三个专家共识小组制定了逐步的、资源适当的建议，以在低收入和中等收入国家以及高收入国家中服务不足的社区实施这些指南。每个小组都专注于乳腺癌护理的三个特定方面之一：1）早期检测，2）治疗，3）加强卫生系统。
峰会的主要发现和随后的文章准备包括在共识辩论中探讨的分阶段实施前提的确定。这些核心问题和概念是考虑实际资源限制实施乳腺保健的关键组成部分。各级护理的沟通和参与对于任何有效运作的医疗保健系统都是至关重要的，包括与卫生部和财政部进行有效的沟通，以展示需求、结果和成本效益。
所有经济水平的服务不足社区都需要有效的策略来部署稀缺资源，以确保及时、有效和负担得起的医疗保健。需要系统的战略方法将指南转化为实践，以建立卫生系统能力，以应对当前和预期的全球乳腺癌负担。
