TY - JOUR

T1 - Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America

T2 - protocol for the EquityCancer-LA implementation-effectiveness hybrid study

AU - Vazquez, Maria-Luisa

AU - Vargas, Ingrid

AU - Rubio-Valera, Maria

AU - Aznar-Lou, Ignacio

AU - Eguiguren, Pamela

AU - Mogollon-Perez, Amparo-Susana

AU - Torres, Ana-Lucia

AU - Peralta, Andres

AU - Dias, Sonia

AU - Jervelund, Signe Smith

AU - EquityCancer-LA

PY - 2022

Y1 - 2022

N2 - IntroductionHealthcare 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 analysisThis 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 (alpha=0.05; beta=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 disseminationThis 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.

AB - IntroductionHealthcare 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 analysisThis 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 (alpha=0.05; beta=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 disseminationThis 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.

KW - change management

KW - organisation of health services

KW - quality in health care

KW - medical education & training

KW - adult oncology

KW - health policy

KW - BREAST-CANCER

KW - COMPLEX INTERVENTIONS

KW - BEHAVIORAL-MODEL

KW - MEDICAL-CARE

KW - PROGRAM

KW - DESIGN

KW - DELAY

KW - TELEMEDICINE

KW - MANAGEMENT

KW - ONCOLOGY

U2 - 10.1136/bmjopen-2022-067439

DO - 10.1136/bmjopen-2022-067439

M3 - Journal article

C2 - 36523219

VL - 12

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 12

ER -