Subramanian Sujha, Tangka Florence K L, Hoover Sonja, DeGroff Amy
RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA, 02452-8413, USA.
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Implement Sci Commun. 2022 Oct 5;3(1):105. doi: 10.1186/s43058-022-00353-8.
Screening for colorectal, breast, and cervical cancer has been shown to reduce mortality; however, not all men and women are screened in the USA. Further, there are disparities in screening uptake by people from racial and ethnic minority groups, people with low income, people who lack health insurance, and those who lack access to care. The Centers for Disease Control and Prevention funds two programs-the Colorectal Cancer Control Program and the National Breast and Cervical Cancer Early Detection Program-to help increase cancer screenings among groups that have been economically and socially marginalized. The goal of this manuscript is to describe how programs and their partners integrate evidence-based interventions (e.g., patient reminders) and supporting activities (e.g., practice facilitation to optimize electronic medical records) across colorectal, breast, and cervical cancer screenings, and we suggest research areas based on implementation science.
We conducted an exploratory assessment using qualitative and quantitative data to describe implementation of integrated interventions and supporting activities for cancer screening. We conducted 10 site visits and follow-up telephone interviews with health systems and their partners to inform the integration processes. We developed a conceptual model to describe the integration processes and reviewed screening recommendations of the United States Preventive Services Task Force to illustrate challenges in integration. To identify factors important in program implementation, we asked program implementers to rank domains and constructs of the Consolidated Framework for Implementation Research.
Health systems integrated interventions for all screenings across single and multiple levels. Although potentially efficient, there were challenges due to differing eligibility of screenings by age, gender, frequency, and location of services. Program implementers ranked complexity, cost, implementation climate, and engagement of appropriate staff in implementation among the most important factors to success.
Integrating interventions and supporting activities to increase uptake of cancer screenings could be an effective and efficient approach, but we currently do not have the evidence to recommend widescale adoption. Detailed multilevel measures related to process, screening, and implementation outcomes, and cost are required to evaluate integrated programs. Systematic studies can help to ascertain the benefits of integrating interventions and supporting activities for multiple cancer screenings, and we suggest research areas that might address current gaps in the literature.
结直肠癌、乳腺癌和宫颈癌筛查已被证明可降低死亡率；然而，在美国并非所有男性和女性都接受筛查。此外，少数种族和族裔群体、低收入人群、缺乏医疗保险的人群以及无法获得医疗服务的人群在筛查接受率方面存在差异。疾病控制与预防中心资助了两个项目——结直肠癌控制项目和国家乳腺癌与宫颈癌早期检测项目——以帮助提高在经济和社会上处于边缘地位的群体的癌症筛查率。本文的目的是描述这些项目及其合作伙伴如何在结直肠癌、乳腺癌和宫颈癌筛查中整合基于证据的干预措施（如患者提醒）和支持活动（如促进优化电子病历的实践），并基于实施科学提出研究领域。
我们使用定性和定量数据进行了一项探索性评估，以描述癌症筛查综合干预措施和支持活动的实施情况。我们对卫生系统及其合作伙伴进行了10次实地考察和后续电话访谈，以了解整合过程。我们开发了一个概念模型来描述整合过程，并审查了美国预防服务工作组的筛查建议，以说明整合中的挑战。为了确定对项目实施重要的因素，我们要求项目实施者对实施研究综合框架的领域和结构进行排名。
卫生系统在单一和多个层面上整合了所有筛查的干预措施。尽管可能有效率，但由于筛查在年龄、性别、频率和服务地点方面的资格要求不同，存在一些挑战。项目实施者将复杂性、成本、实施氛围以及合适工作人员参与实施列为成功的最重要因素。
整合干预措施和支持活动以提高癌症筛查接受率可能是一种有效且高效的方法，但我们目前没有证据推荐广泛采用。需要与过程、筛查、实施结果和成本相关的详细多层次措施来评估综合项目。系统研究有助于确定整合干预措施和支持活动以进行多种癌症筛查的益处，我们提出了可能填补当前文献空白的研究领域。
