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

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4 626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％)、部门间协调(24.4％)和机构间沟通衔接困难(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 according to the local situations.Results regarding the "willingness to provide service" showed that management of the program should also be strengthened,including information system building and inter-agency and inter-department coordination at the government levels.