A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening
A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening
复制标题
DOI：
10.1093/jnci/djh134
复制
发表时间：
2004-05-19
影响因子：
10.3
通讯作者：
Engelhard, D
中科院分区：
文献类型：
--
作者：
Church, TR;Yeazel, MW;Engelhard, D
工作背景：尽管通过粪便潜血试验（FOBT）、乙状结肠镜检查、结肠镜检查或钡灌肠X线检查进行的结直肠癌筛查可降低结直肠癌的发病率和死亡率，但一般人群中结直肠癌筛查率较低。我们进行了一项随机试验，包括直接邮寄FOBT试剂盒，以增加明尼苏达州赖特县居民的结直肠癌筛查，该社区推广结直肠癌筛查。研究方法：在基线时，我们将一份关于结直肠癌筛查的问卷邮寄给从明尼苏达州驾照和身份证数据库中随机选择的50岁或以上的赖特县居民（估计N = 1451）。样本被随机分配到三个相等的亚组：一组（对照组）只收到问卷，一组收到FOBT套件直接邮寄提醒，一组收到FOBT套件直接邮寄没有提醒。研究参与者在基线后1年发送了一份随访问卷。我们使用对问卷的回答来估计每组自我报告的筛查率的1年变化以及组间变化的差异，沿着相关的bootstrap 95%置信区间（CI）。结果如下：基线时，估计应答率为86.5%，自我报告的FOBT指南依从性为21.5%，总体依从任何结直肠癌筛查试验指南为55.8%。自我报告的坚持FOBT使用的1年绝对百分比变化率为1.5%（95% CI = -2.9%至5.9%），对照组为16.9%（95% CI = 11.5%至22.3%），直邮FOBT无提醒组为23.2%（95% CI = 17.2%至29.3%）。自我报告的任何结直肠癌筛查试验依从性的I年变化率为7.8%（95% CI 3.2%至12.0%），对照组为13.2%（95% CI 8.4%至18.2%），直邮FOBT无提醒组为14.1%（95% CI = 9.1%至19.1%），直邮FOBT有提醒组为14.1%。结论：直接邮寄FOBT试剂盒结合随访提醒促进了FOBT使用的快速增加，与社区范围的筛查宣传和宣传活动相比，普通人群中结肠直肠癌筛查指南的总体依从率几乎增加了一倍。
Background: Although colorectal cancer screening by using a fecal occult blood test (FOBT), flexible sigmoidoscopy, colonoscopy, or barium enema x-ray reduces the incidence of and death from colorectal cancer, the rate of colorectal cancer screening in the general population is low. We conducted a randomized trial consisting of direct mailing of FOBT kits to increase colorectal cancer screening among residents of Wright County, Minnesota, a community in which colorectal cancer screening was promoted. Methods: At baseline, we mailed a questionnaire about colorectal cancer screening to a random sample of Wright County residents aged 50 years or older who were randomly selected from the Minnesota State Driver's License and Identification Card database (estimated N = 1451). The sample was randomly allocated into three equal subgroups: one group (control) received only the questionnaire, one group received FOBT kits by direct mail with reminders, and one group received FOBT kits by direct mail without reminders. Study participants were sent a follow-up questionnaire 1 year after baseline. We used the responses to the questionnaires to estimate the 1-year change in self-reported screening rates in each group and the differences in the changes among the groups, along with the associated bootstrap 95% confidence intervals (CIs). Results: At baseline, the estimated response rate was 86.5%, self-reported adherence to FOBT guidelines was 21.5%, and overall adherence to any colorectal cancer screening test guidelines was 55.8%. The 1-year rate changes in absolute percentage for self-reported adherence to FOBT use were 1.5% (95% CI = -2.9% to 5.9%) for the control group, 16.9% (95% CI = 11.5% to 22.3%) for the directmail-FOBT-with-no-reminders group, and 23.2% (95% CI = 17.2% to 29.3%) for the direct-mail-FOBT-with-reminders group. The I-year rate changes for self-reported adherence to any colorectal cancer screening test were 7.8% (95% CI 3.2% to 12.0%) for the control group, 13.2% (95% CI 8.4% to 18.2%) for the direct-mail-FOBT-with-no-reminders group, and 14.1% (95% CI = 9.1% to 19.1%) for the direct-mail-FOBT-with-reminders group. Conclusion: Direct mailing of FOBT kits combined with follow-up reminders promotes more rapid increases in the use of FOBT and nearly doubles the increase in overall rate of adherence to colorectal cancer screening guidelines in a general population compared with a community-wide screening promotion and awareness campaign.