社区乳腺癌高危人群筛查实施的障碍和促进因素：对妇女、组织者和提供者的访谈研究
Barriers and Facilitators to Implementation of Screening for High-risk Populations of Breast Cancer in Communities: an Interview Study with Women, Organizers and Providers
周明瑶 1张柳柳 2韩仁强 3陆宁宁 4王丹 1程芳1
作者信息
- 1. 210000 江苏省南京市，南京医科大学护理学院
- 2. 210000 江苏省南京市，南京医科大学附属肿瘤医院
- 3. 210000 江苏省南京市，江苏省疾病预防控制中心慢性非传染性疾病防制所
- 4. 222000 江苏省连云港市，南京医科大学康达学院
- 折叠
摘要
背景 当前乳腺癌发病率居高不下，国家卫生健康委员会开展的“城市癌症早诊早治项目”旨在推动癌症高危人群早诊早治，但调查结果显示，乳腺癌高危妇女的筛查现状不容乐观。目的 探讨乳腺癌高危人群筛查实施的障碍和促进因素，为制订针对性实施策略提供依据。方法 于2024年9—11月，采用便利抽样法在江苏省南京市选取6家社区卫生服务中心和唯一1家定点筛查医院作为研究场所，同时按照最大差异抽样法原则对参与筛查工作的医务人员及乳腺癌高危妇女进行半结构化访谈。基于实施性研究综合框架（CFIR）的5个维度和48个构成要素构建访谈提纲，采用自上而下和内容分析法进行数据分析。结果 共访谈了16名乳腺癌高危妇女、12名社区卫生服务中心医务人员和10名定点筛查医院医务人员。筛查服务供方层面障碍因素包括候检和报告出具时间过长、风险评估结果解读能力有限、面向筛查需方信息传递不足、供方人力和时间需求未充分满足，促进因素包括内部协作顺畅、反思工作充分；筛查需方层面障碍因素包括数字排斥、信息可及性受限、能力不足、动机薄弱，促进因素包括感知风险和益处、社会支持充足。结论 乳腺癌高危人群筛查实施存在多层次障碍和促进因素，未来需制订针对性实施策略，以促进乳腺癌筛查工作顺利开展，同时为“城市癌症早诊早治项目”整体推进提供借鉴意义。
Abstract
BackgroundCurrently, the incidence of breast cancer remains high. The "Cancer Screening Program in Urban China" program, initiated by the National Health Commission, aims to promote early diagnosis and treatment among high-risk populations. However, survey results indicate that the current status of screening among high-risk women is still suboptimal. ObjectiveTo explore the barriers and facilitators of screening implementation among the high-risk population for breast cancer, and to provide a basis for formulating targeted implementation strategies. MethodsFrom September to November 2024, six community health service centers and the sole designated screening hospital in Nanjing, Jiangsu Province, were selected as study sites using convenience sampling. Semi-structured interviews were conducted with medical staff involved in screening work and high-risk women for breast cancer, following the principle of maximum variation sampling. Researchers constructed interview outlines based on the five dimensions and 48 constructs of the Consolidated Framework for Implementation Research (CFIR). And the interview data were analyzed using the content analysis method combined with the top-down approach. ResultsA total of 16 high-risk women for breast cancer, 12 medical personnel from community health service centers, and 10 medical personnel from the designated screening hospital were interviewed. At the screening provider level, barriers included long waiting times for examination and report issuance, limited capacity in interpreting risk assessment results, insufficient information transmission to screening demanders, and unmet human resource and time needs of providers. Facilitators included smooth internal collaboration and adequate reflective work. At the screening recipient level, barriers included digital exclusion, limited information accessibility, insufficient capacity, and weak motivation. Facilitators included perceived risk and benefits, and adequate social support. ConclusionThere are multi-level barriers and facilitators in screening implementation for high-risk populations of breast cancer. Future efforts should focus on developing targeted implementation strategies to promote the smooth conduct of breast cancer screening, while also providing insights for the overall advancement of the Cancer Screening Program in Urban China program.关键词
乳腺肿瘤/癌症早期检测/定性研究/实施性研究综合框架引用本文复制引用
周明瑶,张柳柳,韩仁强,陆宁宁,王丹,程芳.社区乳腺癌高危人群筛查实施的障碍和促进因素：对妇女、组织者和提供者的访谈研究[EB/OL].(2026-05-21)[2026-05-23].https://chinaxiv.org/abs/202605.00145.学科分类
医学研究方法/预防医学/肿瘤学
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