Situational analysis of breast health care systems: Why context matters

Catherine Duggan; Allison Dvaladze; John R Scheel; Lisa M Stevens; Benjamin O Anderson

doi:10.1002/cncr.32899

Situational analysis of breast health care systems: Why context matters

Cancer. 2020 May 15:126 Suppl 10:2405-2415. doi: 10.1002/cncr.32899.

Authors

Catherine Duggan¹, Allison Dvaladze^{1

2}, John R Scheel^{1

3

4}, Lisa M Stevens⁵, Benjamin O Anderson^{1

4

6}

Affiliations

¹ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
² University of Washington, Seattle, Washington, USA.
³ Department of Radiology, Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA.
⁴ Department of Global Health, University of Washington, Seattle, Washington, USA.
⁵ Division of Programme of Action for Cancer Therapy (PACT), International Atomic Energy Agency, Vienna, Austria.
⁶ Department of Surgery, Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA.

PMID: 32348576
DOI: 10.1002/cncr.32899

Abstract

Background: Implementation of evidence-based, resource-appropriate guidelines for breast cancer control should be preceded by a baseline assessment or situational analysis to assess breast health infrastructure, workforce capacity, patient pathways, existing practices, accessibility, and costs.

Methods: To support the assessment of breast health care systems within the broader context in which they exist, the Breast Health Global Initiative (BHGI) developed, tested, and refined a set of situational analysis tools with which to guide the assessment of breast health care capacity, identify the relative strengths and weaknesses of the health system, and support stakeholders in prioritizing actionable items to advance breast cancer care using evidence-based strategies tailored to their setting. The tools address 6 domains of breast health care delivery: 1) breast cancer early detection practices; 2) breast cancer awareness programs; 3) the availability of breast cancer surgery; 4) the availability of pathology; 5) the availability of radiotherapy, and 6) the availability of systemic therapy services. The current study also describes the more comprehensive International Atomic Energy Agency Programme of Action for Cancer Therapy (PACT) integrated missions for PACT (imPACT) review.

Results: As of 2020, 5 formal BHGI situational analyses have been performed in India, Brazil, Panama, Tanzania, and Uganda. As of August 2019, a total of 100 imPACT reviews have been conducted in 91 countries. These assessments can contribute to more informed policymaking.

Conclusions: Situational analyses are a prerequisite for the development of resource-appropriate strategies with which to advance breast cancer control in any setting and should assess services across the entire breast health care continuum as well as the broader structural, sociocultural, personal, and financial contexts within which they operate.

Keywords: breast health care; context; health system assessments; implementation science; resource stratification; situational analysis.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Brazil
Breast Neoplasms / diagnosis*
Breast Neoplasms / therapy*
Delivery of Health Care
Developing Countries
Early Detection of Cancer
Evidence-Based Medicine
Female
Global Health
Health Knowledge, Attitudes, Practice
Health Plan Implementation / legislation & jurisprudence
Health Plan Implementation / methods*
Humans
India
Panama
Practice Guidelines as Topic
Tanzania
Uganda

Abstract

Publication types

MeSH terms

Grants and funding