Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial
Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial
复制标题
DOI：
10.1007/s11606-015-3234-5
复制
发表时间：
2015-08-01
影响因子：
5.7
通讯作者：
Baker, David W.
中科院分区：
文献类型：
--
作者：
Goldman, Shira N.;Liss, David T.;Baker, David W.
弱势群体的结直肠癌 (CRC) 筛查率较低。粪便免疫化学测试（FIT）是一种几乎没有障碍的筛查方式。研究表明，外展活动可以改善结直肠癌筛查，但对于没有结直肠癌筛查历史的个体的有效性知之甚少。我们试图确定与常规护理相比，外展活动是否会增加没有 CRC 筛查历史的患者对 FIT 的采用。这项研究是一项患者水平的随机对照试验，包括 420 名从未完成 CRC 筛查且有资格接受 FIT 的患者； 66% 是女性，62.1% 是拉丁裔，70.7% 没有保险。主要结果指标是随机化日期后 6 个月内完成 FIT。我们在与收到外展组件相对应的不同时间点评估了 FIT 完成情况。所有分析均使用 12 个月的数据重新进行。接受外展服务的患者比接受常规护理的患者更有可能完成 FIT（36.7% 对比 14.8%；p < 0.001）。在就诊次数增多的患者中，完成 FIT 的情况更为常见。随着时间的推移，外展组和常规护理组之间 FIT 完成情况的差异逐渐缩小。干预措施提高了没有 CRC 筛查史的患者对 FIT 的接受度。然而，与之前针对需要重复筛查的患者的试验相比，该干预措施的效果较差。需要进行更多研究来确定改善这一难以接触人群的结直肠癌筛查的最佳方法。
Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care.This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data.Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p < 0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time.The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.