In the first part of this talk on planning a screening program, we've seen the first four key components of implementations which are the objectives, the decision aid, the operational policies, and the computerized invitation systems. We're now moving to the fifth component, which is setting the infrastructure you need to deliver your screening programs, and also the subsequent diagnostic investigations. What is the optimum setting, that you desire when decide which location should screening be delivered? If you consider breast cancer screening for instance, you may have the choice between having dedicated breast screening units, you may integrate your program within the current centers, or you may consider having some mobile or fixed units, so just trailers, according to the spread of the population you have to going to cover. So it is this kind of questions you need to address in the settings. Once you have done that, you also need to ensure a sufficient workload for the quality of your programs in different centers. We know that the more volume of screenings being perform is associated with a higher quality. You need to ensure the equipment meet some standards. Specific procedures sometimes have to be met. For instance, sedations for colonoscopy. If you have to deal with biological materials such as feces or blood, you need to address all the transportation and storage of the screening test to be performed. Also, in your screening centers, you may want to monitor the waiting times to ensure that people invited to screen don't have to wait too long before they can perform that test. So it’s all of this kind of elements and documents that will need to be considered in the tasks that you may require from this collaborating centers. There has been recently an emergence of assessment centers, sometimes considered as one-stop clinics, which enable at the same time to have the testing and the diagnostic of the screening positive people to be done. This enables a rapid diagnostic and care without delays And generally has the highest report which is associated also with a high quality of screening. It's of course not available for all type of screening. It is easier, for instance, to do a biopsy after a positive breast mammography than to undergo a colonoscopy after a positive FOBT test, which cannot be done within a one-stop clinic. So all this element of settings are important to consider and will depend on your local area. The sixth element is communications. You need to ensure appropriate informations, which is clear, consistent, and professional. So it's a good idea to hire professional communication officer to deal with that. You have many target agencies including health authorities, service users, patients, various patient organizations, health service staff, and the media. Regarding the general public, your material should be easy to read, comprehensive, and understandable. According to your area, you may want to have material available in different languages. You also may want to include information for people with special needs or people who have no dedicated general practitioners. You may want to consider specific information for people screened positive, what to expect next. And for people in all the disease we confirmed, what are the next step for them? And of course, your communication material needs to be updated in view of new evidence or new policies which may come. It is also a good idea to include representatives of patient organizations when developing your material, and test your material in a pilot group to see if the language you use is really clear to most people. The simplest elements is the coordinations and management of the screening programs. We have seen it is a broad multidisciplinary endeavor and It is important to ensure that elements that make up your program work well together. So you need to have a formal conspicuous identity that will represent the screening programs, and formalize the ongoing liaison between all the stakeholders. So key factors to consider here is to appoint a program director who has CLIA qualifications, and to identify lead people for each element of the program. You want to establish boards, executive boards, medical boards, or scientific boards who will meet regularly and can deal with all the issues we will come up during a screening programs. These conditions can be made nationally or even locally according to the setting and the delivery of your screening program. But if it is a local delivery, you probably need both, you need a local and a national coordinations for your programs. The eighth component is the quality control. It is important to monitor the quality of the equipment, of the staff involved in the programs, and the performance of your program. So you need to set objective and standards. In Europe and for cancer of the cervix, of colorectal and breast cancers, there is European guidelines that will help you to achieve set standards that have been defined by a group of experts. Other countries, at the US, Australia, New Zealand, they have their own standard for this cancer screening. So it's important, regardless of the kind of disease you develop, to have established standards for trying to achieve the standards you want. Then you need to measure the performance against the standard, to ensure that appropriate actions are taken when the standards are not met. Finally, the last component is the research. Research can be part of the evaluation of a service screening programs. It aims on improving the quality and the performance of the screening. It can look at the volume, for instance, of screening and the performance of different actors at ways of measuring, minimizing harm, of understanding the mechanism of participation, so it can help you in many aspects. It is important that the research results should feed into the policy settings and the practice of your programs. So, in conclusions, the planning phase of programs takes several years, if you want to do a high quality screening programs, that multidisciplinary approach is essential to deliver programs, and there are several key components, we've detailed nine of them, and that these components may vary according to the settings in which your programs is being planned.
