Department of Nursing and Physiotherapy, University of Lleida-IRBLleida, Lleida, Spain.
Health Care Research Group (GRECS), Lleida, Spain.
PLoS One. 2022 Feb 4;17(2):e0263788. doi: 10.1371/journal.pone.0263788. eCollection 2022.
With the aim of increasing benefits and decreasing harms, risk-based breast cancer screening has been proposed as an alternative to age-based screening. This study explores barriers and facilitators to implementing a risk-based breast cancer screening program from the perspective of health professionals, in the context of a National Health Service.
Socio-constructivist qualitative research carried out in Catalonia (Spain), in the year 2019. Four discussion groups were conducted, with a total of 29 health professionals from primary care, breast cancer screening programs, hospital breast units, epidemiology units, and clinical specialties. A descriptive-interpretive thematic analysis was performed.
Identified barriers included resistance to reducing the number of screening exams for low-risk women; resistance to change for health professionals; difficulties in risk communication; lack of conclusive evidence of the benefits of risk-based screening; limited economic resources; and organizational transformation. Facilitators include benefits of risk-based strategies for high and low-risk women; women's active role in their health care; proximity of women and primary care professionals; experience of health professionals in other screening programs; and greater efficiency of a risk-based screening program. Organizational and administrative changes in the health system, commitment by policy makers, training of health professionals, and educational interventions addressed to the general population will be required.
Despite the expressed difficulties, participants supported the implementation of risk-based screening. They highlighted its benefits, especially for women at high risk of breast cancer and those under 50 years of age, and assumed a greater efficiency of the risk-based program compared to the aged-based one. Future studies should assess the efficiency and feasibility of risk-based breast cancer screening for its transfer to clinical practice.
为了提高收益并减少危害，基于风险的乳腺癌筛查已被提议作为基于年龄的筛查的替代方法。本研究从卫生专业人员的角度探讨了在国家卫生服务背景下实施基于风险的乳腺癌筛查计划的障碍和促进因素。
这是 2019 年在西班牙加泰罗尼亚进行的社会建构主义定性研究。共进行了 4 次讨论小组，共有 29 名来自初级保健、乳腺癌筛查计划、医院乳房科、流行病学科和临床专业的卫生专业人员参加。进行了描述性解释性主题分析。
确定的障碍包括抵制减少低风险女性的筛查检查次数；卫生专业人员对变革的抵制；风险沟通困难；缺乏基于风险的筛查益处的明确证据；经济资源有限；以及组织转型。促进因素包括基于风险的策略对高风险和低风险女性的益处；女性在其医疗保健中的积极作用；女性与初级保健专业人员的接近程度；卫生专业人员在其他筛查计划中的经验；以及基于风险的筛查计划的更高效率。需要对卫生系统进行组织和行政变革、政策制定者的承诺、卫生专业人员的培训以及针对普通民众的教育干预。
尽管存在明显的困难，参与者仍支持实施基于风险的筛查。他们强调了其益处，特别是对于乳腺癌高风险和 50 岁以下的女性，并且假设基于风险的计划比基于年龄的计划效率更高。未来的研究应评估基于风险的乳腺癌筛查的效率和可行性，以便将其转移到临床实践中。
