摘要
目的调查影响胃癌筛查项目实施的有利和不利因素,为改进筛查工作的策略提供依据。方法以实施性研究综合框架为指导,构建半结构化访谈提纲,于2024年12月—2025年1月在甘肃省兰州市、陇南市,对符合研究标准的筛查目标人群与筛查服务提供方开展个人深度访谈。结果防癌知识知晓水平、对胃镜检查的恐惧、胃癌家族史、健康教育、无痛胃镜、检查费用、亲友建议和医生推荐等因素会影响目标人群筛查依从性;政策与经费支持、激励机制、内镜技术水平、技能培训、基层医疗人力水平及质量控制体系等是影响胃癌筛查服务提供方的主要因素。结论相关支持政策、内镜技能培训、完善的质控体系促进了筛查项目实施;防癌知识掌握较好、有胃癌家族史、得到亲友或医生建议的目标人群筛查意愿较高,而无痛胃镜、免费筛查、防癌健康教育能显著提升其筛查主动性。经费不足、激励缺乏、基层卫生服务人力短缺、内镜医师能力不足制约了筛查实施,而缺乏防癌知识、对内镜检查存在恐惧心理及较高的治疗费用阻碍了目标人群参与筛查。
Objective To investigate and analyze the facilitators and barriers in implementing gastric cancer screening,in order to provide evidence for the development of strategies aimed at improving screening efforts.Methods A semi-structured interview outline was constructed by reference to the Comprehensive Framework for Implementation Research.From December 2024 to January 2025,the gastric cancer screening target indi-viduals and the screening service providers who meet the inclusion criteria were selected in Lanzhou and Longnan,Gansu Province,for personal in-depth interviews.Results For target individuals,factors such as lit-eracy of cancer prevention knowledge,fear of endoscopy,family history of gastric cancer,health education,endoscopy under anesthesia,medical costs,suggestions from relatives and friends,and doctor recommenda-tions would affect their compliance in participating the screening.Policy and funding support,incentives,en-doscopy competence,skill training,supply of primary healthcare labor and quality control were factors that impact the supply of gastric cancer screening services.Conclusion Supportive policies,endoscopic skill train-ing and a sound quality control system can facilitate the implementation of screening programs;the individu-als who have a good command of cancer prevention knowledge,have family history of gastric cancer,or are recommended for endoscopy by their family members,friends or doctors exhibit a higher willingness to participate in the screening;the availability of endoscopy under anesthesia,free screening and cancer preven-tion health education promote their screening compliance.However,insufficient funding,lack of incentives,shortage of labor in primary healthcare services,and inadequate competence of endoscopists have hindered the implementation of screening.Moreover,limited knowledge of cancer screening,fear of endoscopic proce-dures,and high treatment costs are barriers for the target individual to participate in the screening.
作者
王雷
朱晓亮
赵艺皓
邵瑞太
WANG Lei;ZHU Xiaoliang;ZHAO Yihao;SHAO Ruitai(School of Population Medicine and Public Health,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Respiratory Health and Multimorbidity,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;The First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China;Department of General Surgery,The First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《兰州大学学报(医学版)》
2025年第8期53-59,共7页
Journal of Lanzhou University(Medical Sciences)
基金
国家重点研发计划资助项目(2022YFC2503602)
中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助项目(2021-RC330-004)
北京协和医学院慢性病群医学基地建设资助项目(WH10022022010)
甘肃省科技计划资助项目(23JDKA0004)。
关键词
胃癌
筛查
胃镜
实施
影响因素
健康教育
质量控制
医疗资源配置
gastric cancer
screening
endoscopy
implementation
influencing factor
health education
quali-ty control
medical resource allocation
