我国城市地区癌症筛查项目人员对筛查工作意愿倾向的多中心调查及政策建议  

Willingness and preferences of actual service suppliers regarding cancer screening programs： a multi-center survey in urban China

作　　者：石菊芳 毛阿燕[2] 孙宗祥[3] 雷海科[4] 邱五七[2] 黄慧瑶 董佩[2] 黄佳文 朱娟 李江 刘国祥[5] 王德斌[6] 白亚娜[7] 孙晓杰[8] 廖先珍[9] 任建松 郭兰伟[10] 兰莉[3] 周琦[4] 杨莉[11] 宋冰冰[12] 杜灵彬[13] 朱琳[14] 王家林[15] 刘玉琴[16] 任英 买玲[10] 秦明芳 张永贞[19] 周金意[20] 孙校华[21] 吴寿岭[22] 齐啸 娄培安[24] 蔡波 李霓 张凯 赫捷 代敏 无 Shi Jufang;Mao Ayan;Sun Zongxiang;Lei Haike;Qiu Wuqi;Huang Huiyao;Dong Pei;Huang Jiawen;Zhu Juan;Li Jiang;Liu Guoxiang;Wang Debin;Bai Yana;Sun Xiaojie;Liao Xianzhen;Ren Jiansong;Guo Lanwei;Lan Li;Zhou Qi;Yang Li;Song Bingbing;Du Lingbin;Zhu Lin;Wang Jialin;Liu Yuqin;Ren Ying;Mai Ling;Qin Mingfang;Zhang Yongzhen;Zhou Jinyi;Sun Xiaohua;Wu Shouling;Qi Xiao;Lou Peian;Cai Bo;Li Ni;Zhang Kai;He Jie;Dai Min(National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China;Harbin Center for Disease Control and Prevention, Harbin 150056, China;Chongqing Cancer Institute, Chongqing 400030, China;Harbin Medical University, Harbin 150081, China;School of Medical Administration, Anhui Medical University, Hefei 230032, China;Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China;Center fov Health Management and Policy of Shandong University, Jinan 250012, China;Hunan Provincial Cancer Hospital, Changsha 410006, China;Henan Cancer Hospital, Zhengzhou 450008, China;Guangxi Medical University, Nanning 530021, China;Affiliated Cancer Hospital of Harbin Medical University, Harbin 150081, China;Zhefiang Cancer Hospital, Hangzhou 310022, China;Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, China;Shandong Tumor Hospital, Jinan 250117, China;Gansu Provincial Cancer Hospital, Lanzhou 730050, China;Tiding Central Hospital, Tiding 112000, China;Yunnan Cancer Hospital, Kunming 650118, China;Shanxi Provincial Cancer Hospital, Taiyuan 030013, China;Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China;Ningbo No.2 Hospital, Ningbo 315010, Chin;Kailuan General Hospital, Tangshan 063000, China;Tangshan People＇s Hospital, Tangshan 063001, China;Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, China;Nantong Tumor Hospital, N

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,北京100021 [2]中国医学科学院北京协和医学院医学信息研究所,北京100020 [3]哈尔滨市疾病预防控制中心,150056 [4]重庆市肿瘤研究所,400030 [5]哈尔滨医科大学卫生管理学院,150081 [6]安徽医科大学卫生管理学院,合肥230032 [7]兰州大学公共卫生学院流行病与卫生统计学研究所,730000 [8]山东大学卫生管理与政策研究中心,济南250012 [9]湖南省肿瘤医院,长沙410006 [10]河南省肿瘤医院,郑州450008 [11]广西医科大学,南宁530021 [12]哈尔滨医科大学附属肿瘤医院,150081 [13]浙江省肿瘤医院,杭州310022 [14]新疆医科大学附属肿瘤医院,乌鲁木齐830011 [15]山东省肿瘤医院,济南250117 [16]甘肃省肿瘤医院,兰州730050 [17]铁岭市中心医院,112000 [18]云南省肿瘤医院,昆明650118 [19]山西省肿瘤医院,太原030013 [20]江苏省疾病预防控制中心,南京210009 [21]宁波市第二医院,315010 [22]开滦总医院,唐山063000 [23]唐山市人民医院,063001 [24]徐州市疾病预防控制中心,221006 [25]南通市肿瘤医院,226000 [26]城市癌症早诊早治项目卫生经济学评价工作组

出　　处：《中华流行病学杂志》2018年第2期142-149,共8页Chinese Journal of Epidemiology

基　　金：国家自然科学基金（81773521,81402740）;WHO2016-2017双年度合作项目（2016/664439-0）;科技部重大慢性非传染性疾病防控专项（2017YFC1308700,2017YFC1308705）;中国医学科学院医学与健康科技创新工程项目（2017-12M-1-006）;国家科技重大专项（2017ZX10201201-008-002）;国家重大公共卫生服务项目--城市癌症早诊早治项目

摘　　要：目的基于癌症筛查实际供方角度，从工作人员主观感受及意愿层面评价癌症筛查项目的可持续性。方法2014—2015年，基于城市癌症早诊早治项目，在16个省份项目点选取2013-2015年所有承担项目的医院、CDC和社区卫生服务中心，采用纸质问卷和网络调查开展访谈，对象包括宏观管理人员、具体项目管理人员和一线工作人员等。结果最终完成访谈4626份，访谈对象总体认为参加项目的最大收获在于社会价值感的提升（63．6％）、当地影响力（35．9％）及专业技能提升（30．6％）等；最大困难在于社会物质激励不够所致工作积极性低（30．9％）、信息采集口径不一致（28．3％）、部门问协调（24．4％）和机构问沟通衔接困难（23．5％）等。当单项筛查服务劳务补偿约50元时，工作人员会考虑加班工作。63．7％的受访者有长期筛查服务意愿，主要原因：可通过项目提升个人／团队在当地影响口碑（48．7％）、通过项目提升个人／团队专业技能（43．1％）等；无服务意愿者主要担心工作量超负荷（59．8％）、对日常工作的干扰（49．8％）等。结论收获与困难相关结果提示，若要长期可持续性开展癌症筛查工作，建议加强项目内荣誉激励、对外宣传及专业能力建设，根据具体情况提高劳务补偿。服务意愿结果则提示，应从政府和领导层面加强信息化建设及机构／部门间协调，机构内应合理协调筛查项目与日常工作。Objective From the perspective of actual service suppliers regarding cancer screening, this study aimed to assess the long-term sustainability of cancer screening programs in China. Methods Based on a Cancer Screening Program in Urban China （CanSPUC）, our survey focused on all the hospitals, centers for disease control and prevention （CDC） and community service centers across 16 provinces in China which participated in the programs between 2013 and 2015. All the managers （institutional/department level） and professional staff involved in the program were interviewed using either paper-based questionnaire or online approach. Results A total of 4 626 participants completed the interview. It showed that the main gains from providing screening service emphasized promotion in social value （63.6%）, local reputation （35.9%）, and professional skills （30.6%）, whereas difficulties encountered included inadequate compensation （30.9%） and discordance among information systems （28.3%）. When the service remuneration amounts to about 50 Chinese Yuan per screening item, those professional staff self-reported that they would like to work overtime. More than half （63.7%） of the staff expressed willingness to provide routine screening service, the main expectations were to promote their reputation to the local residents （48.7%） and to promote professional skills （43.1%）. Those who were not willing to provide screening services were worried about the potential heavy workload （59.8%） or being interfered with their routine work （49.8%）. Further detailed results regarding the different organization types and program roles were presented in the following detailed report. Conclusions Findings of gains and difficulties showed that if cancer screening is expected to become a long-term running, incentive mechanism from the program, external promotion and advocacy as well as capacity building should be strengthened; furthermore, rewards to staff＇s screening services should be raised accor

关 键 词：肿瘤 筛查 服务 供方 可持续性 

分 类 号：R197.1[医药卫生—卫生事业管理]