关键利益相关者对澳大利亚宫颈癌筛查计划中自我采样初始实施的看法：一项定性研究。
-Key Stakeholder Perspectives on the Initial Implementation of Self-Collection in Australia's Cervical Screening Program: A Qualitative Study.
机构信息
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia.
Australian Centre for the Prevention of Cervical Cancer, Melbourne, VIC 3010, Australia.
出版信息
Int J Environ Res Public Health. 2022 Nov 27;19(23):15776. doi: 10.3390/ijerph192315776.
BACKGROUND
In December 2017, the Australian National Cervical Screening Program transitioned from 2-yearly cytology-based to 5-yearly human papillomavirus (HPV)-based cervical screening, including a vaginal self-collection option. Until July 2022, this option was restricted to under- or never-screened people aged 30 years and older who refused a speculum exam. We investigated the perspectives and experiences of stakeholders involved in, or affected by, the initial implementation of the restricted self-collection pathway.
METHODS
Semi-structured interviews were conducted with 49 stakeholders as part of the STakeholder Opinions of Renewal Implementation and Experiences Study. All interviews were audio recorded and transcribed. Data were thematically analysed and coded to the Conceptual Framework for Implementation Outcomes.
RESULTS
Stakeholders viewed the introduction of self-collection as an exciting opportunity to provide under-screened people with an alternative to a speculum examination. Adoption in clinical practice, however, was impacted by a lack of clear communication and promotion to providers, and the limited number of laboratories accredited to process self-collected samples. Primary care providers tasked with communicating and offering self-collection described confusion about the availability, participant eligibility, pathology processes, and clinical management processes for self-collection. Regulatory delay in developing an agreed protocol to approve laboratory processing of self-collected swabs, and consequently initially having one laboratory nationally accredited to process samples, led to missed opportunities and misinformation regarding the pathway's availability.
CONCLUSIONS
Whilst the introduction of self-collection was welcomed, clear communication from Government regarding setbacks in implementation and how to overcome these in practice were needed. As Australia moves to a policy of providing everyone eligible for screening the choice of self-collection, wider promotion to providers and eligible people, clarity around pathology processes and the scaling up of test availability, as well as timely education and communication of clinical management practice guidelines, are needed to ensure smoother program delivery in the future. Other countries implementing self-collection policies can learn from the implementation challenges faced by Australia.
背景
2017 年 12 月，澳大利亚国家宫颈癌筛查计划从每 2 年进行一次细胞学检查改为每 5 年进行一次人乳头瘤病毒（HPV）检查，包括阴道自我采集选项。直到 2022 年 7 月，该选项仅适用于拒绝阴道镜检查且年龄在 30 岁及以上的未筛查或从未筛查过的人群。我们调查了参与或受初始实施限制自我采集途径影响的利益相关者的观点和经验。
方法
作为更新实施和经验研究的利益相关者意见的一部分，对 49 名利益相关者进行了半结构化访谈。所有访谈均进行录音并转录。使用概念框架对数据进行主题分析和编码，以了解实施结果。
结果
利益相关者认为引入自我采集是为未筛查人群提供替代阴道镜检查的一个令人兴奋的机会。然而，在临床实践中，由于缺乏向提供者的明确沟通和宣传，以及处理自我采集样本的实验室数量有限，自我采集的采用受到了影响。负责沟通和提供自我采集的初级保健提供者对可用性、参与者资格、病理过程以及自我采集的临床管理过程感到困惑。在制定一项商定的协议以批准实验室处理自我采集拭子时出现监管延迟，最初只有一家实验室在全国范围内获得处理样本的认证，导致该途径的可用性方面出现了错失的机会和错误信息。
结论
尽管引入自我采集受到欢迎，但政府需要就实施过程中的挫折以及如何在实践中克服这些挫折提供明确的沟通。随着澳大利亚向所有符合条件的筛查者提供自我采集的选择，需要向提供者和符合条件的人更广泛地宣传，明确病理过程和扩大检测可用性，并及时教育和沟通临床管理实践指南，以确保未来更顺利地实施计划。其他实施自我采集政策的国家可以从澳大利亚面临的实施挑战中吸取经验教训。
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