癌症筛查项目人员组成及工作负荷的多中心调查及建议

Constituent and workload of service providers engaged in cancer screening： findings and suggestions from a multi-center survey in China

目的从癌症筛查服务人员组成和工作服务负荷，了解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（71．1％为三甲医院）、CDC和社区中心，采用纸质问卷和网络调查，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，内容包括不同专业人员配备情况、工作人员工作负荷及补偿情况等。结果完成合格调查4626份，年龄（37．7±9．5）岁，男性占31．0％。省份间投人人员数量差别较大，以2012年加入项目的8个可比省份为例，副高及以上人员数量为6人（重庆）至43人（北京）不等；细化不同专业间差别也较大。不同机构来源工作人员中，医院（n=2192）、CDC（n=431）和社区中心人员（n=1990）自报因参加项目工作量增加所致压力较大的占比依次为19．9％、24．6％和34．1％（P〈0．001）。对应不同项目角色分类人员，宏观管理（n=227）、项目具体管理人员（n=376）和一线工作人员（n=3908）自报压力较大的比例依次为23．6％、22．3％和28．2％（P〈0．001）。3244名（73．8％）工作人员为项目工作加班获得报酬或补偿，其中以与工作量挂钩的劳务费（67．5％）和工作量不挂钩劳务费（26．6％）形式最多见。结论省份间人员配置情况提示各现场的组织模式不同，客观能力可能存在差异。若要长期可持续性开展癌症筛查工作，建议筛查工作趋向常规化，减轻社区和一线工作人员压力，提高物质和非物质激励，可设专职人员。

Objective To understand the constituent and workload of service providers engaged in cancer screening in China and provide evidence for the assessment of the sustainability of national cancer screening project. Methods Using either questionnaire or online approach, the survey was conducted in 16 provinces, where Cancer Screening Program in Urban China （CanSPUC） was conducted, from 2014 to 2015. The medical institutes surveyed included hospitals [71.1% were class m （A） hospitals], centers for disease control and prevention （CDCs） and community centers where cancer screening was undertaken during 2013-2015. The questionnaire survey was conducted among the staffs responsible for the overall coordination, management and implementation of the screening project to collect the information about the allocation, workload and compensation of the service providers from different specialties. Results A total of 4 626 staffs were surveyed in this study, their average age was （37.7 ± 9.5） years, and males accounted for 31.0%. Human resources allocated differed with province. The number of senior staff ranged from 6 （Chongqing） to 43 （Beijing） among the 8 comparable provinces. Among the staffs surveyed, 2 192 were from hospitals, 431 were from CDCs and 1 990 were from community centers, and the staffs who complained heavy workload accounted for 19.9%, 24.6% and 34.1% respectively （P〈0.001）. Among 227 staffs for overall coordination, 376 management staffs and 3 908 staffs for implementation, those who complained heavy workload accounted for 23.6%, 22.3% and 28.2% respectively （P〈0.001）. A total of 3 244 staffs （73.8%） got compensations for heavy workload. The compensation types were manly labor fee linked with workload （67.5%） and labor fee regardless workload （26.6%）. Conclusion The province specific differences in human resources allocation indicated the differences in screening project＇ s organizing pattern and capability. It is suggested to conduct routine cancer screening （using specialized staffs）, reduce the workload of the first line and community staffs and increase the compensation for the service providers for the sustainability of cancer screening project in China.