Implementing Cancer Screening Programs by Training Primary Care Physicians in India—Findings from the National Institute of Cancer Prevention Research Project ECHO for Cancer Prevention

Prajakta Adsul,Suzanne Tanya Nethan,Kavitha Dhanasekaran,Roopa Hariprasad,Sasha Herbst Decortina

doi:10.1007/s43477-021-00032-1

Abstract

In 2016, the Government of India launched a national program for screening and prevention of oral, breast, and cervical cancer. In support, the National Institute for Cancer Prevention Research (NICPR) adopted the Project ECHO (Extension for Community Healthcare Outcomes) model for training health care providers in cancer screening. We assess change in knowledge and skills among physicians attending hybrid (i.e., online and in person) NICPR-ECHO trainings and impact on implementation of cancer screening services. Prior to the start of the online phase and upon completion of 14 weeks, trainees answered a 23-item online questionnaire, including visual vignettes. We conducted descriptive and bivariate analysis of pre-post assessments from trainees participating in the online phase and wherever available report on the weekly quizzes and the hands-on workshop assessments. A total of 641 medical officers participated in the trainings from May 2019 to February 2020. Across nine cohorts of trainees, only 116 primary care physicians completed both the pre- and post-assessments. Almost two-thirds completed medical training (69.7%) and 85% were working in government healthcare facilities. Trainees reported statistically significant improvements before and after the online phase, when queried specifically on knowledge and skills using visual vignettes about oral (p < 0.001), breast (p = 0.35), and cervical cancer screening (p < 0.001). Study findings support the effectiveness of Project ECHO in reaching primary care physicians across the country and improving their knowledge and skills related to screening for breast, oral, and cervical cancer, with additional support needed for implementation of clinical cancer screening services.

Highlights

Non-communicable diseases are responsible for a large proportion of mortality and morbidity and continue to be an important public health problem (Dandona et al, 2017)
Since the introduction of the National Institute for Cancer Prevention Research (NICPR)-ECHO in 2016, 641 primary care physicians have participated in the trainings, across nine cohorts of trainees
Almost twothirds of trainees had completed medical training (Remaining medical officers from Primary Health Centres were trained in alternative medicine) (69.7%) and 85% worked in government healthcare facilities

Summary

Introduction

Non-communicable diseases are responsible for a large proportion of mortality and morbidity and continue to be an important public health problem (Dandona et al, 2017). Every year approximately 1,157,294 individuals are diagnosed and 784,821 die due to cancer in India. Oral, and cervical cancer are the three most common cancers occurring in India and account for 34% of all cancers within the country (Bray et al, 2018). For these cancers, screening tests have been demonstrated to help with early detection and thereby prevent mortality due to cancer. In an effort to address this burden, the Government of India’s Ministry of Health and Family Welfare (MoHFW) introduced a national program for screening and prevention of the most common cancers (oral, breast, and cervical) in 2016 (Welfare, 2016)

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