Santiago-Rodríguez Eduardo J, Hoeft Kristin S, Lugtu Kara, McGowen Matthew, Ofman David, Adler Jaime, Somsouk Ma, Potter Michael B
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, CA, USA.
Implement Sci Commun. 2023 May 22;4(1):54. doi: 10.1186/s43058-023-00439-x.
In 2017, the San Francisco Cancer Initiative (SF CAN) established the Colorectal Cancer (CRC) Screening Program to provide technical assistance and financial support to improve CRC screening processes, and outcomes in a consortium of community health centers (CHCs) serving low-income communities in San Francisco. The purpose of this study was twofold: to evaluate the perceived influence of the support provided by the CRC Screening Program's Task Force on CRC screening processes and outcomes in these settings and to identify facilitators and barriers to SF CAN-supported CRC screening activities before and after the onset of the COVID-19 pandemic.
Semi-structured key informant interviews were conducted with consortium leaders, medical directors, quality improvement team members, and clinic screening champions. Interviews were audio-recorded, professionally transcribed, and analyzed for themes. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview questions and organize the analysis.
Twenty-two participants were interviewed. The most commonly cited facilitators of improved screening processes included the expertise, funding, screening resources, regular follow-up, and sustained engagement with clinic leaders provided by the task force. The most salient barriers identified were patient characteristics, such as housing instability; staffing challenges, such as being understaffed and experiencing high staff turnover; and clinic-level challenges, such as lack of ability to implement and sustain formalized patient navigation strategies, and changes in clinic priorities due to the COVID-19 pandemic and other competing health care priorities.
Implementing CRC screening programs in a consortium of CHCs is inherently challenging. Technical assistance from the Task Force was viewed positively and helped to mitigate challenges both before and during the pandemic. Future research should explore opportunities to increase the robustness of technical assistance offered by groups such as SF CAN to support cancer screening activities in CHCs serving low-income communities.
2017年，旧金山癌症倡议组织（SF CAN）设立了结直肠癌（CRC）筛查项目，为改善结直肠癌筛查流程及结果提供技术援助和资金支持，该项目针对的是为旧金山低收入社区服务的社区卫生中心（CHC）联盟。本研究有两个目的：评估CRC筛查项目特别工作组提供的支持对这些机构中CRC筛查流程及结果的感知影响，并确定在2019冠状病毒病大流行前后，SF CAN支持的CRC筛查活动的促进因素和障碍。
对联盟负责人、医疗主任、质量改进团队成员和诊所筛查倡导者进行了半结构化关键信息访谈。访谈进行了录音、专业转录并分析主题。采用实施研究综合框架（CFIR）来制定访谈问题并组织分析。
共访谈了22名参与者。被提及最多的改善筛查流程的促进因素包括特别工作组提供的专业知识、资金、筛查资源、定期随访以及与诊所负责人的持续互动。确定的最突出障碍包括患者特征，如住房不稳定；人员配备挑战，如人员不足和员工流动率高；以及诊所层面的挑战，如缺乏实施和维持正式患者导航策略的能力，以及由于2019冠状病毒病大流行和其他相互竞争的医疗保健优先事项导致诊所优先事项的变化。
在CHC联盟中实施CRC筛查项目本身就具有挑战性。特别工作组提供的技术援助得到了积极评价，并有助于缓解大流行之前和期间的挑战。未来的研究应探索机会，增强SF CAN等组织提供的技术援助的力度，以支持为低收入社区服务的CHC中的癌症筛查活动。
