| 王鑫,毛阿燕,周心怡,董佩,李燕婕,蔡森瑶,吴宇洁,黄慧瑶,刘国祥,徐望红,秦江梅,陈万青,石菊芳.癌症筛查服务可及性的评价指标体系构建：一项Delphi研究[J].Chinese journal of Epidemiology,2025,46(2):307-315 |
| 癌症筛查服务可及性的评价指标体系构建：一项Delphi研究 |
| Development of an evaluation indicator system for access to cancer screening services: a Delphi study |
| Received:June 22, 2024 |
| DOI：10.3760/cma.j.cn112338-20240622-00367 |
| KeyWord: 癌症 筛查 可及性 评价指标体系 Delphi法 |
| English Key Word: Cancer Screening Access Evaluation indicator system Delphi method |
| FundProject:中国医学科学院肿瘤医院人才激励计划；国家自然科学基金（81773521）；中华医学基金会卫生政策与体系科学公开竞标项目（19-340）；北京协和医学院青年医学教育骨干培训项目（2024mesp013） |
| Author Name | Affiliation | E-mail | | Wang Xin | Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China | | | Mao Ayan | Department of Public Health Strategy Informatics, Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China | mao.ayan@imicams.ac.cn | | Zhou Xinyi | Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China | | | Dong Pei | Department of Public Health Strategy Informatics, Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China | | | Li Yanjie | Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China | | | Cai Senyao | Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China | | | Wu Yujie | Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China | | | Huang Huiyao | Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China | | | Liu Guoxiang | School of Health Management, Harbin Medical University, Harbin 150081, China | | | Xu Wanghong | Key Laboratory of Public Health Safety, Ministry of Education-Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China | | | Qin Jiangmei | China National Health Development Research Center, Beijing 100044, China | | | Chen Wanqing | Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China | | | Shi Jufang | Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China | shijf@cicams.ac.cn |
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| Abstract: |
| 目的 构建癌症筛查服务可及性的评价指标体系。方法 采用范围综述法形成评价指标池；基于多源指标构建理论框架，采取定性专家咨询法，形成初版三级评价指标体系。再对其开展两轮Delphi专家咨询进行相关性、重要性和可获得性评价；分析专家积极系数、权威系数、意见协调程度、意见集中程度等，然后基于界值法结合专家开放性意见，调整确定癌症筛查服务可及性的三级评价指标体系，最后采用组合权重法确定权重。结果 初版指标体系包含3个一级指标、11个二级指标以及46个三级指标。对初版进行两轮Delphi咨询，最终有17名专家完成，积极系数为100%，权威系数为0.87。相比第一轮咨询，第二轮对各项三级指标的相关性、重要性和可获得性评分的Kendall's W系数范围有所提高（0.15~0.43，χ2检验均P<0.05）；对重要性维度的评分分析提示，专家意见也更为集中（算术均数>8分和满分比过半的三级指标比例分别提升了8.5%和7.0%）。最终确定的评价指标体系包含了3个一级指标（结构评价、过程评价和结果评价，权重分别为0.338、0.378和0.285）、11个二级指标以及45个三级指标。结论 本研究构建的评价指标体系可为癌症筛查服务在不同人群、癌种以及干预前后的可及性量化比较等情景提供有效评估工具，亦需在应用中持续优化。 |
| English Abstract: |
| Objective To present an evaluation indicator system for access to cancer screening services. Methods The evaluation indicator pool was constructed through a scoping review. The theoretical framework was constructed based on the multi-source indicators, and the qualitative expert consultation method was employed to form the initial version of the three-level evaluation indicator system. Delphi expert consultation method was conducted in two rounds to evaluate the relevance, importance, and availability of the proposed evaluation indicator system. The expert positive coefficient, authority coefficient, coordination degree of expert opinions, and concentration of expert opinions were subjected to analysis. Subsequently, the three-level evaluation indicator system for access to cancer screening services was adjusted and determined based on the boundary value method and the open opinions of experts. Finally, the combination weight method was employed to determine the weight. Results The initial version of the indicator system comprised 3 primary (first-level) indicators, 11 secondary (second-level) indicators, and 46 tertiary (third-level) indicators. Delphi expert consultation was conducted for the initial version, and 17 experts ultimately completed it, exhibiting a positive coefficient of 100% and an authority coefficient of 0.87. In comparison to the initial round of consultation, Kendall's W coefficient ranges (0.15-0.43, all P<0.05) of relevance, importance, and availability scores for each tertiary indicator in the second round exhibited an improvement. The analysis of the importance dimension indicates that expert opinions are also more concentrated, as evidenced by an increase of 8.5% and 7.0% in the proportion of the tertiary indicators with an arithmetic mean above 8 and a full mark ratio above 0.5, respectively. The final evaluation indicator system comprises three primary indicators, with the weights of structure evaluation, process evaluation, and outcome evaluation being 0.338, 0.378, and 0.285, respectively. It also comprises 11 secondary indicators and 45 tertiary indicators. Conclusions The evaluation indicator system developed in this article can be an effective evaluation tool for quantitative comparison of access to cancer screening services across different populations, cancer types, and before and after intervention. Furthermore, it is recommended that the system undergo continuous optimization concerning its application. |
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