Influence of organizational factors on implementation of a personalized approach to breast cancer screening

Objective: Stratification of individuals into risk categories according to genetic and clinical factors will soon improve breast cancer screening programs. This study assessed the influence of organizational factors on the possible implementation of this approach in Quebec. Methods: Semi-structured interviews were conducted with 16 managers and decision-makers involved in the Quebec breast cancer screening program (PQDCS). Results: Thematic analysis of the interviews identified a consensus among interviewees on the need to implement a more personalized risk stratification approach that would be complementary to the PQDCS. Several interviewees were concerned about the human resources required and the roles that doctors and nurses may be called upon to play. Interviewees also raised the issues of adaptation of communication tools to the characteristics of local populations; inter-regional equity of access to services; and the possible effects on the participation rate in the current program (PQDCS). Conclusion: This analysis highlights the importance of the organizational context of the healthcare system within which the risk stratification approach is implemented. Availability of qualified human resources, adaptation of tools to socio-demographic realities and compatibility with measures of performance are among the key considerations.