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1.1 Introduction
Anaplastic thyroid carcinoma (ATC) is an aggressive and usually rapidly fatal tumor with a
median survival after diagnosis of 6 months [Ain et al., 2000; Are and Shaha, 2006; Haddad et
al., 2005]. It accounts for 1–2% of all thyroid carcinomas [Giuffrida and Gharib, 2000;
Smallridge et al., 2009]. Current therapy consists of surgery, radiotherapy or
radiochemotherapy and chemotherapy.

Undertaking a doctoral study is needed to obtain research competences and to have a

qualification of a researcher. Creating an impact in cancer management requires well designed
studies and sustained actions. This proposed study would be a beginning to induce further
studies and programs aiming at making thyroid cancer as a disease of the past in the future.

1.2 Research objectives

The overall aim of the study is to Describes the description of clinical characteristics of thyroid
carcinoma and summarizes the most frequent collection of clinical characteristics found in
thyroid carcinoma to be analyzed for diagnostic value compared with a PA biopsy. The specific
objectives are: 1) Describe the clinical characteristics of thyroid carcinoma, 2) Summarizes and
scores the characteristics of thyroid carcinoma to diagnose thyroid carcinoma, 3) Proving the
sensitivity value of clinical characteristics in thyroid carcinoma compared with PA biopsy, 4).
Proving specificity value of clinical characteristics in thyroid carcinoma compared with PA
biopsy. 5) Proving positive predictive value of clinical characteristics in thyroid carcinoma
compared with PA biopsy. 6) Proves negative predictive value of clinical characteristics in
thyroid carcinoma compared with PA biopsy

2. Method

2.1 Design

The type of this study was observational analytic to look for clinical characteristics of thyroid
carcinoma and calculate diagnostic test values taken within the timeframe from March 2011 to
March 2017. The reasonably affordable population of this study was patients with thyroid

2.2 Population and Sample

The quantitave study will use total sampling of subjects who meet the eligibility criteria and
live in the chosen hospital. The criteria of inclusion for the cervical cancer screening
participants are: 1) All patients with thyroid carcinoma diagnosed with a recorded PA biopsy
of the history and physical examination in Medical Record since 2011; 2) have the willingness
to participate in this study. Patient whose medical record can not be found will be excluded.

2.4 Procedures

Table 1. Preplanned actions and outcomes

2.5 Data Collection

The qualitative data will be obtained through focus group discussion and individual
semistructured interviews. Quantitative data will be collected from the participants: the women
undergoing cervical screening and the screening providers. The field notes, reflective diaries
and the screening results will provide datasets. The evaluation of the programme will be
obtained from both of the community participants and the health care providers.

2.6 Data Analysis

Data from interview and focus group discussion transcripts, field notes and reflective diaries
will be analysed using a constant comparative approach. Data analysis for the quantitative data
will be done using SPSS 22.0 statistical software. Descriptive statistics will be generated to
characterise the research sample in terms of demographic and screening test result variables.
Bivariate and multivariate analysis will be used to evaluate the programme.

2.7 Potential Challenges and Ethical Considerations

The main challenge may arise in initiating and maintaining the involvement of stakeholders,
health care providers and community during the study. Another potentially emerging issue
would be on overcoming the community’s resistance to undergo VIA, even though VIA

procedure has been proven to be safe. Ethical issue may come up if participants feel compelled
to participate in this study. However, it would be anticipated by delivering oral and written
education and debriefing for each prospective subjects about the purpose and procedures of the
study and by highlighting that participation in this study is voluntary and other ethical aspects
of the study. Written informed consent will be given to all participants. The principal
investigator will ensure that this study will be conducted conforming to the research code of
conduct. Ethical approval will be proposed to the Ethics Committee of the Ministry of Health,
Republic of Indonesia.

3. Timetable
Activities Year 1 Year 2 Year 3

1 2 3 4 5 6 7 8 9 1 1 1 1 2 3 4 5 6 7 8 9 1 1 1 1 2 3 4 5 6 7 8
0 1 2 0 1 2

Lit. review
Maturation of
Ethical rev. &
model & plans
Training of
care providers
Training of
Analysis and


4. Conclusion
Organised cervical cancer screening using VIA might increase the coverage of cervical cancer
early detection in an efficient and effective way that would, in turn, reduce the morbidity and
mortality rate of cervical cancer among Indonesian women. Therefore, it is essential to develop
and test the organised approach of cervical cancer screening using VIA in the given context of
Indonesia. This proposed study aims to initiate an organised screening by thoroughly

identifying the needs, possible barriers and strategies for an organised cervical cancer
screening, developing the model and subsequently implementing and examining the
programme. This study has the potential to impact the coverage of cervical cancer screening in
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