Abstract
孙宗祥,石菊芳,兰莉,毛阿燕,黄慧瑶,雷海科,邱五七,董佩,朱娟,王德斌,刘国祥,白亚娜,孙晓杰,廖先珍,任建松,郭兰伟,周琦,杨莉,宋冰冰,杜灵彬,朱琳,龚继勇,刘玉琴,任英,买玲,秦明芳,张永贞,周金意,孙校华,吴寿岭,齐啸,娄培安,蔡波,张凯,赫捷,代敏.癌症筛查项目人员组成及工作负荷的多中心调查及建议[J].Chinese journal of Epidemiology,2018,39(3):295-301
癌症筛查项目人员组成及工作负荷的多中心调查及建议
Constituent and workload of service providers engaged in cancer screening: findings and suggestions from a multi-center survey in China
Received:August 31, 2017  
DOI：10.3760/cma.j.issn.0254-6450.2018.03.009
KeyWord: 肿瘤  筛查  供方  可持续性  能力  工作负荷
English Key Word: Neoplasms  Screening  Provider  Sustainability  Capability  Workload
FundProject:国家重大公共卫生服务项目城市癌症早诊早治项目；WHO 2016－2017双年度合作项目（2016/664439-0）；国家自然科学基金（81402740，81773521）；科技部重大慢性非传染性疾病防控专项研究（2017YFC1308700，2017YFC1308705）；国家科技重大专项（2017ZX10201201-008-002）
Author NameAffiliationE-mail
Sun Zongxiang Harbin Center for Disease Control and Prevention, Harbin 150056, China  
Shi Jufang National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China shijf@cicams.ac.cn 
Lan Li Harbin Center for Disease Control and Prevention, Harbin 150056, China llflx@sina.com 
Mao Ayan Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China mao.ayan@imicams.ac.cn 
Huang Huiyao National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Lei Haike Chongqing Cancer Institute, Chongqing 400030, China  
Qiu Wuqi Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Dong Pei Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Zhu Juan National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Wang Debin Anhui Medical University, Hefei 230032, China  
Liu Guoxiang Harbin Medical University, Harbin 150056, China  
Bai Yana Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou 730000, China  
Sun Xiaojie Center for Health Management and Policy Research, Shandong University, Jinan 250012, China  
Liao Xianzhen Hunan Provincial Cancer Hospital, Changsha 410006, China  
Ren Jiansong National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Guo Lanwei The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China  
Zhou Qi Chongqing Cancer Institute, Chongqing 400030, China  
Yang Li Guangxi Medical University, Nanning 530021, China  
Song Bingbing Affiliated Cancer Hospital of Harbin Medical University, Harbin 150081, China  
Du Lingbin Zhejiang Cancer Hospital, Hangzhou 310022, China  
Zhu Lin Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, China  
Gong Jiyong Shandong Tumor Hospital, Jinan 250117, China  
Liu Yuqin Gansu Provincial Cancer Hospital, Lanzhou 730050, China  
Ren Ying Tieling Central Hospital, Tieling 112000, China  
Mai Ling The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China  
Qin Mingfang Yunnan Cancer Hospital, Kunming 650018, China  
Zhang Yongzhen Shanxi Provincial Cancer Hospital, Taiyuan 030013, China  
Zhou Jinyi Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China  
Sun Xiaohua Ningbo No.2 Hospital, Ningbo 315010, China  
Wu Shouling Kailuan General Hospital, Tangshan 063000, China  
Qi Xiao Tangshan People's Hospital, Tangshan 063001, China  
Lou Peian Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, China  
Cai Bo Nantong Tumor Hospital, Nantong 226000, China  
Zhang Kai National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
He Jie Harbin Center for Disease Control and Prevention, Harbin 150056, China  
Dai Min National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
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Abstract:
      目的 从癌症筛查服务人员组成和工作服务负荷，了解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（71.1%为三甲医院）、CDC和社区中心，采用纸质问卷和网络调查，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，内容包括不同专业人员配备情况、工作人员工作负荷及补偿情况等。结果 完成合格调查4 626份，年龄（37.7±9.5）岁，男性占31.0%。省份间投入人员数量差别较大，以2012年加入项目的8个可比省份为例，副高及以上人员数量为6人（重庆）至43人（北京）不等；细化不同专业间差别也较大。不同机构来源工作人员中，医院（n=2 192）、CDC（n=431）和社区中心人员（n=1 990）自报因参加项目工作量增加所致压力较大的占比依次为19.9%、24.6%和34.1%（P<0.001）。对应不同项目角色分类人员，宏观管理（n=227）、项目具体管理人员（n=376）和一线工作人员（n=3 908）自报压力较大的比例依次为23.6%、22.3%和28.2%（P<0.001）。3 244名（73.8%）工作人员为项目工作加班获得报酬或补偿，其中以与工作量挂钩的劳务费（67.5%）和工作量不挂钩劳务费（26.6%）形式最多见。结论 省份间人员配置情况提示各现场的组织模式不同，客观能力可能存在差异。若要长期可持续性开展癌症筛查工作，建议筛查工作趋向常规化，减轻社区和一线工作人员压力，提高物质和非物质激励，可设专职人员。
English Abstract:
      Objective To understand the constituent and workload of service providers engaged in cancer screening in China and provide evidence for the assessment of the sustainability of national cancer screening project. Methods Using either questionnaire or online approach, the survey was conducted in 16 provinces, where Cancer Screening Program in Urban China (CanSPUC) was conducted, from 2014 to 2015. The medical institutes surveyed included hospitals[71.1% were class Ⅲ(A) hospitals], centers for disease control and prevention (CDCs) and community centers where cancer screening was undertaken during 2013-2015. The questionnaire survey was conducted among the staffs responsible for the overall coordination, management and implementation of the screening project to collect the information about the allocation, workload and compensation of the service providers from different specialties. Results A total of 4 626 staffs were surveyed in this study, their average age was (37.7±9.5) years, and males accounted for 31.0%. Human resources allocated differed with province. The number of senior staff ranged from 6 (Chongqing) to 43 (Beijing) among the 8 comparable provinces. Among the staffs surveyed, 2 192 were from hospitals, 431 were from CDCs and 1 990 were from community centers, and the staffs who complained heavy workload accounted for 19.9%, 24.6% and 34.1% respectively (P<0.001). Among 227 staffs for overall coordination, 376 management staffs and 3 908 staffs for implementation, those who complained heavy workload accounted for 23.6%, 22.3% and 28.2% respectively (P<0.001). A total of 3 244 staffs (73.8%) got compensations for heavy workload. The compensation types were manly labor fee linked with workload (67.5%) and labor fee regardless workload (26.6%). Conclusion The province specific differences in human resources allocation indicated the differences in screening project's organizing pattern and capability. It is suggested to conduct routine cancer screening (using specialized staffs), reduce the workload of the first line and community staffs and increase the compensation for the service providers for the sustainability of cancer screening project in China.
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