Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study
Introduction Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the reg...
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BMJ Publishing Group
2022-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e067439.full |
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| author | Virginia García Sónia Dias María-Luisa Vázquez Ingrid Vargas Pamela Eguiguren Josep Maria Borràs Ignacio Aznar-Lou Antoni Serrano-Blanco Montserrat Gil-Girbau Maria Rubio-Valera Maria Luisa Garmendia Daniel Ruiz Amparo-Susana Mogollón-Pérez Ana-Lucía Torres Andrés Peralta Signe Smith Jervelund M.L. Vazquez Aida Oliver Verónica Espinel Zahara Fernández Paula Arroyo-Uriarte Ana María Oyarce Camilo Bass Isabel Guzmán Andrea Alvarez Paola González Isabel Abarca Rodney Stock Berta Cerda Guillermo Hartwig Cristopher Tabilo Carmen Aravena Gloria Stephens Ana Maria Pedraza Angela Pinzón Carol Cardozo María Camila Rangel Pablo Cristancho William Mantilla Guillermo León Juan Merchán Iván Dueñas Hugo Pereira Estefanía Rodríguez |
| author_facet | Virginia García Sónia Dias María-Luisa Vázquez Ingrid Vargas Pamela Eguiguren Josep Maria Borràs Ignacio Aznar-Lou Antoni Serrano-Blanco Montserrat Gil-Girbau Maria Rubio-Valera Maria Luisa Garmendia Daniel Ruiz Amparo-Susana Mogollón-Pérez Ana-Lucía Torres Andrés Peralta Signe Smith Jervelund M.L. Vazquez Aida Oliver Verónica Espinel Zahara Fernández Paula Arroyo-Uriarte Ana María Oyarce Camilo Bass Isabel Guzmán Andrea Alvarez Paola González Isabel Abarca Rodney Stock Berta Cerda Guillermo Hartwig Cristopher Tabilo Carmen Aravena Gloria Stephens Ana Maria Pedraza Angela Pinzón Carol Cardozo María Camila Rangel Pablo Cristancho William Mantilla Guillermo León Juan Merchán Iván Dueñas Hugo Pereira Estefanía Rodríguez |
| collection | DOAJ |
| description | Introduction Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador.Methods and analysis This research is two pronged: (A) quasi-experimental design (controlled before and after) with an intervention and a control healthcare network in each LA country, using an implementation-effectiveness hybrid approach to assess the intervention process, effectiveness and costs; and (B) case study design to analyse access to diagnosis of most frequent cancers. Focusing on the most vulnerable socioeconomic population, it develops in four phases: (1) analysis of delays and barriers to early diagnosis (baseline); (2) intervention adaptation and implementation (primary care training, fast-track referral pathway and patient information); (3) intracountry evaluation of intervention and (4) cross-country analysis. Baseline and evaluation studies adopt mixed-methods qualitative (semistructured individual interviews) and quantitative (patient questionnaire survey) methods. For the latter, a sample size of 174 patients with cancer diagnosis per healthcare network and year was calculated to detect a proportions difference of 15%, before and after intervention (α=0.05; β=0.2) in a two-sided test. A participatory approach will be used to tailor the intervention to each context, led by a local steering committee (professionals, managers, policy makers, patients and researchers).Ethics and dissemination This study complies with international and national legal stipulations on ethics. It was approved by each country’s ethical committee and informed consent will be obtained from participants. Besides the coproduction of knowledge with key stakeholders, it will be disseminated through strategies such as policy briefs, workshops, e-tools and scientific papers. |
| format | Article |
| id | doaj-art-112aa2f4db6941bab045c2fa89c14ca8 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-112aa2f4db6941bab045c2fa89c14ca82025-08-20T02:11:31ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2022-067439Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study 0Virginia García1Sónia Dias2María-Luisa Vázquez3Ingrid Vargas4Pamela Eguiguren5Josep Maria BorràsIgnacio Aznar-Lou6Antoni Serrano-Blanco7Montserrat Gil-GirbauMaria Rubio-Valera8Maria Luisa GarmendiaDaniel RuizAmparo-Susana Mogollón-Pérez9Ana-Lucía Torres10Andrés Peralta11Signe Smith Jervelund12M.L. VazquezAida OliverVerónica EspinelZahara FernándezPaula Arroyo-UriarteAna María OyarceCamilo BassIsabel GuzmánAndrea AlvarezPaola GonzálezIsabel AbarcaRodney StockBerta CerdaGuillermo HartwigCristopher TabiloCarmen AravenaGloria StephensAna Maria PedrazaAngela PinzónCarol CardozoMaría Camila RangelPablo CristanchoWilliam MantillaGuillermo León13Juan MerchánIván DueñasHugo PereiraEstefanía RodríguezSPRinG Network, Severn and Peninsula Deaneries, UK2Hospital Universitario La Paz, Madrid, Spain1 National School of Public Health, Universidade NOVA de Lisboa, Lisbon, PortugalHealth Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, SpainHealth Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, SpainEscuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, ChileCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Research and Development Unit, Institut de Recerca Sant Joan de Deu, Barcelona, Spain2 CIBER Epidemiology and Public Health, CIBERESP, Barcelona, SpainCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, SpainEscuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, ColombiaPublic Health Institute, Pontificia Universidad Católica del Ecuador, Quito, EcuadorPublic Health Institute, Pontificia Universidad Católica del Ecuador, Quito, EcuadorDepartment of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DenmarkInstituto Clodomiro Picado, Universidad de Costa Rica, San Jose, Costa RicaIntroduction Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador.Methods and analysis This research is two pronged: (A) quasi-experimental design (controlled before and after) with an intervention and a control healthcare network in each LA country, using an implementation-effectiveness hybrid approach to assess the intervention process, effectiveness and costs; and (B) case study design to analyse access to diagnosis of most frequent cancers. Focusing on the most vulnerable socioeconomic population, it develops in four phases: (1) analysis of delays and barriers to early diagnosis (baseline); (2) intervention adaptation and implementation (primary care training, fast-track referral pathway and patient information); (3) intracountry evaluation of intervention and (4) cross-country analysis. Baseline and evaluation studies adopt mixed-methods qualitative (semistructured individual interviews) and quantitative (patient questionnaire survey) methods. For the latter, a sample size of 174 patients with cancer diagnosis per healthcare network and year was calculated to detect a proportions difference of 15%, before and after intervention (α=0.05; β=0.2) in a two-sided test. A participatory approach will be used to tailor the intervention to each context, led by a local steering committee (professionals, managers, policy makers, patients and researchers).Ethics and dissemination This study complies with international and national legal stipulations on ethics. It was approved by each country’s ethical committee and informed consent will be obtained from participants. Besides the coproduction of knowledge with key stakeholders, it will be disseminated through strategies such as policy briefs, workshops, e-tools and scientific papers.https://bmjopen.bmj.com/content/12/12/e067439.full |
| spellingShingle | Virginia García Sónia Dias María-Luisa Vázquez Ingrid Vargas Pamela Eguiguren Josep Maria Borràs Ignacio Aznar-Lou Antoni Serrano-Blanco Montserrat Gil-Girbau Maria Rubio-Valera Maria Luisa Garmendia Daniel Ruiz Amparo-Susana Mogollón-Pérez Ana-Lucía Torres Andrés Peralta Signe Smith Jervelund M.L. Vazquez Aida Oliver Verónica Espinel Zahara Fernández Paula Arroyo-Uriarte Ana María Oyarce Camilo Bass Isabel Guzmán Andrea Alvarez Paola González Isabel Abarca Rodney Stock Berta Cerda Guillermo Hartwig Cristopher Tabilo Carmen Aravena Gloria Stephens Ana Maria Pedraza Angela Pinzón Carol Cardozo María Camila Rangel Pablo Cristancho William Mantilla Guillermo León Juan Merchán Iván Dueñas Hugo Pereira Estefanía Rodríguez Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study BMJ Open |
| title | Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study |
| title_full | Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study |
| title_fullStr | Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study |
| title_full_unstemmed | Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study |
| title_short | Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study |
| title_sort | improving equity in access to early diagnosis of cancer in different healthcare systems of latin america protocol for the equitycancer la implementation effectiveness hybrid study |
| url | https://bmjopen.bmj.com/content/12/12/e067439.full |
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