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| Name | Class |
|---|---|
| Rwanda Biomedical Centre | OTHER |
| Partners in Health | OTHER |
| Breast Cancer Research Foundation | OTHER |
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This observational study evaluates scale-up of a breast cancer early detection program in Rwanda that was initially piloted in a single district. Specifically investigators will examine patient volume, service delivery, loss-to-follow-up rates, and cancer detection rates noted following implementation of scale-up to 3 additional districts. For scaleup, breast cancer screening with CBE was added to a cervical cancer screening initiative, in a combined Women's Cancer Early Detection Program (WCEDP).
Investigators previously conducted a cluster randomized controlled trial of a clinician training program to facilitate prompt evaluation of women with breast symptoms in one rural district of Rwanda. Subsequently, Rwanda Biomedical Centre (RBC) has scaled up the curriculum in 3 districts, adapting the program to integrate CBE screening into a cervical cancer screening initiative. In this study, we will evaluate implementation of this combined screening initiative. Investigators will assess patient volume, services, diagnoses, and loss to follow up.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Screening plus EMR | Individuals in this group are those residing in districts where health facilities have implemented a breast cancer screening program integrated with cervical cancer screening, the Women's Cancer Early Detection Program (WCEDP). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Early diagnosis program combined with electronic medical record | Other | Implementation of early diagnosis approach targeting symptomatic women, combined with use of electronic medical record to facilitate documentation, patient tracking across levels of the health care system, and patient contact |
| Measure | Description | Time Frame |
|---|---|---|
| Cancer detection rate | Proportion of patients presenting to health centers who are ultimately diagnosed with cancer; proportion of patients who receive biopsy who are ultimately diagnosed with cancer; proportion of individuals diagnosed with cancer who initially presented with versus without breast symptoms | 2 years |
| Loss to follow-up | Rates of loss-to-follow up before and after implementation of electronic medical record in districts utilizing breast cancer screening approach; and loss to follow up in districts implementing early diagnosis approach and EMR | one year |
| Patient volume and services received | Number of patients presenting at the health centers, district hospital and referral hospitals | two years |
| Measure | Description | Time Frame |
|---|---|---|
| Breast cancer stage | Among women diagnosed with breast cancer, distribution of cancer stage among women who participated in the WCEDP. | 2 years |
| Patients' costs | out-of-pocket costs borne by patients while undergoing evaluation for an abnormal clinical breast exam |
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Inclusion Criteria:
Exclusion Criteria:
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The study population is the population served by the health centers that are implementing the nationally-led breast cancer early detection program.
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| Name | Affiliation | Role |
|---|---|---|
| Lydia Pace | Brigham and Women's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rwanda Biomedical Centre | Kigali | Rwanda |
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| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| D003550 | Cystic Fibrosis |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
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| ID | Term |
|---|---|
| D057286 | Electronic Health Records |
| ID | Term |
|---|---|
| D016347 | Medical Records Systems, Computerized |
| D008499 | Medical Records |
| D011996 | Records |
| D003625 | Data Collection |
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|
| 6 months |
| D017437 |
| Skin and Connective Tissue Diseases |
| D010182 | Pancreatic Diseases |
| D004066 | Digestive System Diseases |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D007232 | Infant, Newborn, Diseases |
| D004812 |
| Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |