A Randomized Trial to Compare a Tailored Web-Based Intervention and Tailored Phone Counseling to Usual Care for Increasing Colorectal Cancer Screening.
A Randomized Trial to Compare a Tailored Web-Based Intervention and Tailored Phone Counseling to Usual Care for Increasing Colorectal Cancer Screening.
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一项随机试验，将基于Web的干预和量身定制的电话咨询与通常的护理进行比较，以增加结直肠癌筛查。
DOI：
10.1158/1055-9965.epi-18-0180
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发表时间：
2018-12
期刊：
影响因子：
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通讯作者：
Rawl SM
中科院分区：
文献类型：
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作者：
Champion VL;Christy SM;Rakowski W;Gathirua-Mwangi WG;Tarver WL;Carter-Harris L;Cohee AA;Marley AR;Jessup NM;Biederman E;Kettler CD;Stump TE;Monahan P;Lairson DR;Rawl SM
通过风险适当的癌症筛查可以降低结直肠癌死亡率。我们检查了三种定制干预措施与常规护理相比在提高筛查依从性方面的功效。来自初级保健网络且不遵守结直肠癌指南的 51 至 74 岁女性 (n=1196) 被随机分配至：1) 常规护理，2) 定制的网络干预，3) 定制的电话干预，或 4) 定制的网络 + 电话干预。平均风险的女性可以选择粪便测试或结肠镜检查，而被认为高于平均风险的女性则接受支持结肠镜检查的干预措施。结果数据在 6 个月时通过自我报告收集，随后进行病历确认（流失率为 23%）。在基线和 6 个月时评估结直肠癌筛查的变化阶段（预先考虑或考虑）。与常规护理 (11.1%) 相比，电话 (41.7%，p<.0001) 和网络 + 电话相结合 (35.8%，p<.001) 干预措施显着增加了通过粪便测试进行的结直肠癌筛查，在针对协变量调整的模型中，优势比范围为 5.4 至 6.8。结肠镜检查的完成率在各组之间没有差异，只是与自我报告的癌症恐惧最高三分之一的参与者的常规护理相比，电话显着增加了结肠镜检查的完成率。与常规护理相比，带有或不带有网络组件的定制电话显着增加了结直肠癌筛查，主要是通过粪便检测；与常规护理相比，电话显着增加了结肠镜检查，但仅限于基线恐惧水平最高的人群。这项研究支持有或没有网络程序的定制电话咨询，以增加平均风险女性的结直肠癌筛查。
Colorectal cancer mortality could be decreased with risk-appropriate cancer screening. We examined the efficacy of three tailored interventions compared to Usual Care for increasing screening adherence. Women (n=1196) ages 51 to 74, from primary care networks and non-adherent to colorectal cancer guidelines were randomized to: 1) Usual Care, 2) tailored Web intervention, 3) tailored Phone intervention, or 4) tailored Web + Phone intervention. Average-risk women could select either stool test or colonoscopy, while women considered at higher than average risk received an intervention that supported colonoscopy. Outcome data were collected at 6 months by self-report followed by medical record confirmation (attrition of 23%). Stage-of-change for colorectal cancer screening (Precontemplation or Contemplation) was assessed at baseline and 6 months. The Phone (41.7%, p<.0001) and combined Web+Phone (35.8%, p<.001) interventions significantly increased colorectal cancer screening by stool test compared to Usual Care (11.1%) with odds ratios ranging from 5.4 to 6.8 in models adjusted for covariates. Colonoscopy completion did not differ between groups, except that Phone significantly increased colonoscopy completion compared to usual care for participants in the highest tertile of self-reported fear of cancer. A tailored Phone with or without a Web component significantly increased colorectal cancer screening compared to Usual Care, primarily through stool testing, and phone significantly increased colonoscopy compared to usual care but only among those with the highest levels of baseline fear. This study supports tailored phone counseling with or without a web program for increasing colorectal cancer screening in average risk women.