Tata Memorial Centre, Mumbai, India.
Homi Bhabha National Institute, Mumbai, India.
BMJ Glob Health. 2022 Aug;7(8). doi: 10.1136/bmjgh-2022-009584.
To address the wide variation in access to cancer care in India requires strengthening of infrastructure, trained oncology workforce, and minimisation of out-of-pocket expenditures. However, even with major investments, it is unlikely to achieve the same level of infrastructure and expertise across the country. Therefore, a resource stratified approach driven by evidence-based and contextualised clinical guidelines is the need of the hour. The National Cancer Grid has been at the forefront of delivery of standardised cancer care through several of its initiatives, including the resource-stratified guidelines. Development of new guidelines is resource and time intensive, which may not be feasible and can delay the implementation. Adaptation of the existing standard guidelines using the transparent and well-documented methodology with involvement of all stakeholders can be one of the most reasonable pathways. However, the adaptation should be done keeping in mind the context, resource availability, budget impact, investment needed for implementation and acceptability by clinicians, patients, policymakers, and other stakeholders. The present paper provides the framework for systematically developing guidelines through adaptation and contextualisation. The process can be used for other health conditions in resource-constraint settings.
为了解决印度癌症治疗可及性的巨大差异，需要加强基础设施、培训肿瘤学专业人员，并减少自付支出。然而，即使进行了重大投资，也不太可能在全国范围内实现相同水平的基础设施和专业知识。因此，需要一种基于循证和情境化临床指南的资源分层方法。国家癌症网格通过其多项举措，包括资源分层指南，一直处于提供标准化癌症治疗的前沿。制定新的指南需要资源和时间，这可能不可行，并可能延迟实施。使用透明和记录完善的方法，让所有利益相关者参与，对现有标准指南进行改编可以是最合理的途径之一。但是，改编时应考虑到背景、资源可用性、预算影响、实施所需的投资以及临床医生、患者、政策制定者和其他利益相关者的可接受性。本文提供了通过改编和情境化来系统制定指南的框架。该过程可用于资源有限环境中的其他健康状况。
