Developing and validating key performance indicators for breast, cervical, and colorectal cancer screening programs: a literature review and Delphi survey

TL;DR

This study identifies 30 key performance indicators for breast, cervical, and colorectal cancer screening programs, validated by experts to ensure relevance and applicability across healthcare systems.

Contribution

The study introduces a validated set of 30 KPIs for cancer screening programs, combining literature review and expert consensus.

Findings

30 indicators were categorized into input, process, and outcome dimensions.

High content validity index (≥ 0.9) was achieved through expert panel agreement.

Process dimension includes 16 indicators like diagnostic evaluation and referral rates.

Abstract

Early detection of cancer significantly impacts disease management and contributes to a reduction in cancer mortality rates. This study aims to identify, extract, systematize, and validate a set of indicators for breast, cervical, and colorectal cancer screening programs that are applicable and easily understood within any healthcare system.

This study is conducted in two phases: a literature review and an expert panel evaluation. In the first phase, electronic databases—PubMed, Web of Science, and Scopus—were searched for articles published from January 2000 to November 2023. Two reviewers critically appraised the articles based on predefined inclusion and exclusion criteria. Indicators were extracted from the selected articles through content analysis. In the second phase, the extracted indicators were reviewed by ten experts. Consensus on the indicators was achieved through two consecutive rounds of review.

The final list comprises 30 indicators categorized into three dimensions: two for input, sixteen for process, and twelve for outcome. The overall content validity index (CVI) and content validity ratio (CVR) determined using the expert panel agreement approach, were high (≥ 0.9). The input dimension includes two indicators: Adequacy and Availability of Human Resources, and Percentage of Health Centers Providing Cancer Screening Services. The process dimension comprises 16 indicators, including Timely Diagnostic Evaluation of Abnormal Screenings, Rescreening, Recall Rate, Percentage of Smears per 1,000 Women Aged 20–29 per Year, Public Education, Data Availability, Referral Rates (to GP and Surgeon), Drop Rate During Referral, Biopsy Rate, Diagnostic and Therapeutic Endoscopy Rate, Proportion of Colonoscopies, Total and Partial Mastectomy Rates, Tumor Diameter, and Tumor Grading. Finally, the outcome dimension features 12 indicators: Screening Coverage, All-Cause Mortality Rate, Cause-Specific Mortality Rate, Invasive Cancer Detection Rate, Interval Cancer Rate, Ductal Carcinoma in Situ (DCIS) Rate, Cancer Detection Rate, Polyp Detection Rate, Fecal Occult Blood Test (FOBt) Positivity Rate, Adenoma Detection Rate, Positive Predictive Value for Cancer Detection (PPV), and Episode Sensitivity.

This study identified a robust set of 30 key performance indicators (KPIs) for breast, cervical, and colorectal cancer screening programs, with a high overall content validity index demonstrating strong expert consensus on their relevance and importance.

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