Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies.
Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies.
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DOI：
10.1001/archinternmed.2012.332
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发表时间：
2012-04-09
影响因子：
--
通讯作者：
Hayward, Rodney A.
中科院分区：
文献类型：
--
作者：
Inadomi, John M.;Vijan, Sandeep;Janz, Nancy K.;Fagerlin, Angela;Thomas, Jennifer P.;Lin, Yunghui V.;Munoz, Roxana;Lau, Chim;Somsouk, Ma;El-Nachef, Najwa;Hayward, Rodney A.
尽管有证据表明几种结直肠癌（CRC）筛查策略可以降低CRC死亡率，但筛查率仍然很低。本研究旨在确定推荐的筛查方法是否会影响依从性。我们采用以门诊时间区为单位的整群随机化设计。在一个种族/民族多样化的城市环境中，处于CRC发展平均风险的人被随机分配接受粪便潜血试验（FOBT）、结肠镜检查或他们选择的FOBT或结肠镜检查的筛查建议。主要结局是在入组后12个月内完成CRC筛查，定义为进行结肠镜检查，或对于任何阳性FOBT结果，3张FOBT卡加结肠镜检查。次要分析评价了与完成筛选相关的社会人口学因素。共有997名参与者入组; 58%的人完成了他们分配或选择的CRC筛查策略。然而，被推荐结肠镜检查的参与者完成筛查的比例（38%）显著低于被推荐FOBT的参与者（67%）（P< .001）或在FOBT或结肠镜检查之间进行选择的参与者（69%）（P< .001）。拉丁美洲人和亚洲人（主要是中国人）完成筛查的频率高于非洲裔美国人。此外，非白色受试者更常坚持FOBT，而白色受试者更常坚持结肠镜检查。普遍推荐结肠镜检查的常见做法可能会降低对CRC筛查的依从性，特别是在种族/少数民族中。种族/族裔群体之间的总体和特定策略依从性存在显著差异;然而，这可能是健康信念和/或语言的代表。这些结果表明，患者的喜好时，应考虑作出CRC筛查建议。clinicals.gov标识符：NCT 00705731
Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence. We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening. A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P< .001) or given a choice between FOBT or colonoscopy (69%) (P< .001). Latinos and Asians (primarily Chinese) completed screening more often than African Americans. Moreover, non-white participants adhered more often to FOBT, while white participants adhered more often to colonoscopy. The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations. clinicals.gov Identifier: NCT00705731
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影响因子：
3.8
作者：
Maxwell AE;Crespi CM;Antonio CM;Lu P
通讯作者：
Lu P
影响因子：
10.3
作者：
NEWCOMB, PA;NORFLEET, RG;MARCUS, PM
通讯作者：
MARCUS, PM
影响因子：
39.2
作者：
MULLER, AD;SONNENBERG, A
通讯作者：
SONNENBERG, A
DOI：
10.1001/jama.1995.03520280048038
发表时间：
1995-01-25
影响因子：
120.7
作者：
REDELMEIER, DA;SHAFIR, E
通讯作者：
SHAFIR, E
DOI：
10.1093/gerona/62.12.1435
发表时间：
2007-12-01
影响因子：
5.1
作者：
Heisler, Michele;Cole, Ian;Hayward, Rodney A.
通讯作者：
Hayward, Rodney A.