Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities.
Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities.
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DOI：
10.3390/ijerph20227030
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发表时间：
2023-11-07
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阿拉斯加部落卫生系统正在努力增加阿拉斯加原住民的结直肠癌（CRC）筛查，他们的CRC发病率是世界上最高的。本研究探讨CRC筛查提供者和系统级的障碍和促进者的角度为阿拉斯加土著人在农村/偏远社区的医疗保健提供者。2021年2月1日至11月30日，共对28名提供者（医生、高级实践和社区卫生助理/从业人员）进行了访谈。结肠镜检查提供者层面的障碍主题包括时间、竞争优先事项和人员配备，而系统层面的障碍包括旅行成本、天气和COVID-19大流行。多靶点粪便DNA（mt-sDNA）屏障主题包括测试可行性和不熟悉性，以及以前的粪便测试经验。对于这两种测试，有限的医疗记录提醒是一个主要障碍。两个测试的主持人主题包括社区外展，文化能力和患者导航，以及诊所/系统改进。对部落健康提供者的深入采访表明，增加mt-sDNA检测可能有助于解决系统层面的结肠镜检查障碍，如等待名单和旅行费用，但其他障碍仍然存在。需要进一步研究患者的障碍和促进因素，以及将mt-sDNA整合到地理上分散的部落卫生系统中的有效性，以减少癌症差异，并在阿拉斯加原住民中建立CRC预防的公平性。
The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers serving Alaska Native people in rural/remote communities. A total of 28 provider (physicians, advanced practice, and Community Health Aides/Practitioners) interviews were held from 1 February to 30 November 2021. Colonoscopy provider-level barrier themes included time, competing priorities, and staffing, while system-level barriers included travel costs, weather, and the COVID-19 pandemic. Multi-target stool DNA (mt-sDNA) barrier themes included test viability and unfamiliarity, and previous stool tests experiences. For both tests, limited medical record reminders was a major barrier. Facilitator themes for both tests included community outreach, cultural competency and patient navigation, and clinic/system improvements. In-depth interviews with tribal health providers showed that adding mt-sDNA testing may help address system-level colonoscopy barriers such as waitlists and travel costs, but other barriers remain. Further research is needed into patient barriers and facilitators, as well as the effectiveness of integrating mt-sDNA into a geographically dispersed tribal health system to reduce cancer disparities and build equity in CRC prevention among Alaska Native people.