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Informing prostate cancer screening policy makers in the European Union: lessons from cancer screening governance and policymaking.
Prostate cancer (PCa) poses a significant global health threat, with high incidence and mortality rates. In 2022, the Council of the European Union (EU) updated its screening recommendations, prioritizing PCa screening. This signals a crucial step towards establishing new early detection programmes in EU member states. This study investigates the role of policy makers and governance in cancer screening to inform the development of PCa screening. We had a mixed-method study design. First, a rapid review was conducted on policy making and governance in EU-funded cancer screening initiatives. Second, a focus group discussion reviewed study concepts and methods. Third, a systematic literature review was performed and, fourth, a series of in-depth interviews with actors involved in PCa screening pilots was conducted. Data were analysed thematically and the findings are used to propose 10 recommendations for policy makers. The results of the rapid review and focus group discussion framed the study in the context of existing cancer screening programmes across the EU, and highlighted what already exists in terms of governance tools and methodology. The literature review and in-depth interviews presented key learnings from the literature and real-life settings. These findings are reported using a pre-existing conceptional framework for effective health system governance. The study underscores the critical importance of governance in effective cancer screening programmes. Ten recommendations are proposed, including: defining cancer screening governance, allocating budgets and defining common approaches and key performance indicators for evaluation, establishing methods to enhance citizen participation, and reinforcing network governance.
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A scoping review of the barriers and facilitators in the use of traditional, complementary, and integrative medicine: insights for health policy development.
Background: The historical and cultural importance of traditional, complementary, and integrative medicine (TCIM) is observable in diverse contexts and among different populations. As the use of TCIM continues to grow globally, policymakers need to acknowledge its importance in healthcare services. Objectives: We conducted a scoping review of quantitative, qualitative, and mixed-method research to identify the factors that promote and hinder the adoption of TCIM. Methods: This scoping review involved a comprehensive search of online databases from 2000 to February 2024. The review utilized the methodology suggested by Arksey and O'Malley. Qualitative content analysis was employed to synthesize the data. Findings: From a total of 1403 articles retrieved, 61 full-text articles were chosen for the final analysis. Among these, 47 examined facilitators, 4 addressed barriers, and 10 investigated both barriers and facilitators of using TCIM. Three key themes were recognized concerning barriers to using TCIM services, including "service delivery problems", "governance challenges", and "personal barriers". Six key themes associated with the factors facilitating the use of TCIM services were recognized, which include "financial facilitators", "health conditions", "personal determinants", "perceived benefits", "social impact", and "appropriate service delivery". Conclusions: Exploring the barriers and facilitators of using TCIM services can provide valuable insights to policymakers, enabling them to develop strategies to overcome existing challenges and enhance the support for the growth of these services. This knowledge is essential for making sure that TCIM services are available to people in a safe, prompt, and high-quality way.
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Methodological proposals for developing trustworthy recommendations of integrative Chinese-Western medicine
Background: To refine the methods of developing clinical practice guidelines (CPGs) for integrative ChineseWestern medicine (ICWM), promoting the formation of trustworthy, implementable recommendations that integrate the strengths of Chinese and Western medicine. Methods: Using a nominal group technique (NGT) approach, a multidisciplinary expert panel was established. The panel identified key methodological issues in ICWM-CPG development through literature review and iterative discussions, and formulated methodological proposals to address these issues. The final set of proposals was achieved through consensus among the panel members. Results: The collaborative effort resulted in the identification of five pivotal methodological issues and the subsequent establishment of 22 specific recommendations. These encompass strict adherence to renowned standards, such as those proposed by the Institute of Medicine (IOM) and Guidelines International Network (G -I -N), the employment of methodologies like the GRADE approach and RIGHT statement, the strategic constitution of a balanced development group, the adept identification of ICWM-focused clinical inquiries, the nuanced integration of diverse evidence sources, and the detailed crafting of transparent, implementable recommendations. Conclusions: This study concentrates on the most crucial and prevalent methodological issues in ICWM-CPG development, proposing a series of recommendations. These suggestions result from a multidisciplinary expert consensus, aiming to provide methodological guidance for ICWM-CPG developers, building upon the current foundational methodologies.
期刊论文
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The effectiveness of integrative health care for chronic disease: A systematic review
BACKGROUND: The past few decades have witnessed a surge in consumer, clinician and academic interest in the field of integrative health care (IHC). Yet, there is still uncertainty regarding the effectiveness of IHC for complex, long-term health conditions. OBJECTIVE: To assess the effectiveness of IHC for the management of any chronic health condition. METHODS: Seven databases and four clinical trial registries were searched from inception through to May 2018 for comparative/controlled clinical trials investigating the effectiveness of IHC for any chronic disease, and assessing any outcome. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. RESULTS: The search yielded 6,926 results. Eight studies met the inclusion criteria. All studies had at least three design features that carried an uncertain/high risk of bias. Differences in physiological, psychological and functional outcomes, and quality of life between patients receiving IHC and patients receiving conventional/usual care were varied and inconsistent. Changes in patient satisfaction with care were inconclusive. No studies reported the effectiveness of IHC on workforce- or administration-related parameters. Evidence from one trial suggested IHC may be more cost-effective than conventional care. CONCLUSIONS: The findings indicate some promising effects for the use of IHC to manage chronic disease. However, the uncertain/high-risk of bias across multiple domains, diverse and inconsistent findings, and heterogeneity of outcome measures and study populations prevents firm conclusions from being reached. Along with conducting further well-designed, long-term studies in this field, there is a need to ensure interventions closely align with the definition/principles of IHC.
研究证据
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The effectiveness of integrative healthcare for chronic disease: A systematic review
BACKGROUND: The past few decades have witnessed a surge in consumer, clinician and academic interest in the field of integrative healthcare (IHC). Yet, there is still uncertainty regarding the effectiveness of IHC for complex, long-term health conditions. OBJECTIVE: To assess the effectiveness of IHC for the management of any chronic health condition. METHODS: Seven databases and four clinical trial registries were searched from inception through to May 2018 for comparative/controlled clinical trials investigating the effectiveness of IHC for any chronic disease, and assessing any outcome. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. RESULTS: The search yielded 6,926 results. Eight studies met the inclusion criteria. All studies had at least three design features that carried an uncertain/high risk of bias. Differences in physiological, psychological and functional outcomes, and quality of life between patients receiving IHC and patients receiving conventional/usual care were varied and inconsistent. Changes in patient satisfaction with care were inconclusive. No studies reported the effectiveness of IHC on workforce- or administration-related parameters. Evidence from one trial suggested IHC may be more cost-effective than conventional care. CONCLUSIONS: The findings indicate some promising effects for the use of IHC to manage chronic disease. However, the uncertain/high risk of bias across multiple domains, diverse and inconsistent findings, and heterogeneity of outcome measures and study populations prevents firm conclusions from being reached. Along with conducting further well-designed, long-term studies in this field, there is a need to ensure interventions closely align with the definition/principles of IHC.
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