TY - JOUR
T1 - Assessment and improvement strategies for a breast cancer early detection program in rural South Africa
AU - Hadley, Megan
AU - Mullen, Lisa A.
AU - Dickerson, Lindsay
AU - Harvey, Susan C.
N1 - Publisher Copyright:
© 2018 by American Society of Clinical Oncology
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Purpose To assess and develop solutions for an ultrasound-based breast cancer early detection program in rural South Africa 1 year after implementation. Methods A WHO-endorsed RAD-AID Radiology Readiness Assessment was used to evaluate clinic resources. In addition, 5 weeks of observation identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders' input and the BI-RADS, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results Resource limitations included lack of computers, unpredictable electrical supply, and inconsistent Internet. The assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. Furthermore, limitations negatively affected communication among providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking data base compliant with BI-RADS. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent indicated positive general attitudes, and 100% agreed that the documentation system is easy and useful and improves overall quality of care, follow-up, decision making; access to clinical information; and communication between clinicians and patients. Five of the seven providers reported that the system increased visit time, but three of those five believed that the process was valuable. Conclusion Implementation of a breast cancer early detection program in resource-limited regions is challenging, and continual assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Future steps should focus on increasing efficiency, evaluation of provider attitudes long term, and clinical effect.
AB - Purpose To assess and develop solutions for an ultrasound-based breast cancer early detection program in rural South Africa 1 year after implementation. Methods A WHO-endorsed RAD-AID Radiology Readiness Assessment was used to evaluate clinic resources. In addition, 5 weeks of observation identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders' input and the BI-RADS, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results Resource limitations included lack of computers, unpredictable electrical supply, and inconsistent Internet. The assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. Furthermore, limitations negatively affected communication among providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking data base compliant with BI-RADS. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent indicated positive general attitudes, and 100% agreed that the documentation system is easy and useful and improves overall quality of care, follow-up, decision making; access to clinical information; and communication between clinicians and patients. Five of the seven providers reported that the system increased visit time, but three of those five believed that the process was valuable. Conclusion Implementation of a breast cancer early detection program in resource-limited regions is challenging, and continual assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Future steps should focus on increasing efficiency, evaluation of provider attitudes long term, and clinical effect.
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U2 - 10.1200/JGO.18.00015
DO - 10.1200/JGO.18.00015
M3 - Article
C2 - 30085890
AN - SCOPUS:85060562141
SN - 2378-9506
VL - 2018
SP - 1
EP - 12
JO - Journal of Global Oncology
JF - Journal of Global Oncology
IS - 4
ER -