Effect of Patient Characteristics on Uptake of Screening Using a Mailed Human Papillomavirus Self-sampling Kit: A Secondary Analysis of a Randomized Clinical Trial.
Effect of Patient Characteristics on Uptake of Screening Using a Mailed Human Papillomavirus Self-sampling Kit: A Secondary Analysis of a Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2022.44343
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发表时间：
2022-11-01
影响因子：
13.8
通讯作者：
Buist, Diana S. M.
中科院分区：
文献类型：
--
作者：
Winer, Rachel L.;Lin, John;Tiro, Jasmin A.;Miglioretti, Diana L.;Beatty, Tara;Gao, Hongyuan;Kimbel, Kilian;Thayer, Chris;Buist, Diana S. M.
本随机临床试验评估患者特征与邮寄人乳头瘤病毒自采样试剂盒干预筛查摄取的有效性之间的关系。邮寄人乳头瘤病毒自采样试剂盒与常规护理（门诊筛查提醒）对宫颈癌筛查吸收的有效性是否因患者特征而改变？在这项随机临床试验数据的二次分析中，邮寄试剂盒与常规护理相比，在年龄、种族和民族、筛查史以及其他社会人口统计学和健康特征的所有亚组中，筛查显著增加。低筛检持续时间越长，相对影响越大。这些发现表明邮寄工具包增加了对患者特征的筛查，并有机会优化优先亚组的自我抽样。邮寄人乳头瘤病毒（HPV）自采样试剂盒增加宫颈癌筛查的参与，但效果可能在亚人群中有所不同。亚人群数据可以为美国卫生保健系统的实施提供信息。确定在增加筛查时改变邮寄试剂盒干预效果的患者特征。这是对2014年至2018年在华盛顿凯撒医疗机构进行的基于家庭的宫颈癌筛查选择（HOME）随机临床试验数据的二次分析。数据分析时间为2018年3月至2022年5月。年龄在30 - 64岁之间的女性，健康计划登记时间超过3年零5个月，目前有初级保健临床医生，在过去3年零5个月没有进行Papanicolaou检查，通过电子病历确定并随机（1:1）分配到对照组或干预组。对照组接受常规护理帕帕尼科劳筛查提醒和外展。干预组接受常规护理和主动邮寄的HPV自采样试剂盒。随机分组后6个月内捕获筛查摄取情况。从电子病历中提取基线患者特征（年龄、种族、民族、到诊所的旅行时间、收入、体重指数、烟草使用、健康计划登记时间、距离上次帕帕尼科拉氏试验的时间、乳房x光检查、合并症和结直肠癌筛查依从性）。在19 734例个体（平均[SD]年龄50.1[9.5]岁；14 129 [71.6%]White）中，9843例随机分为干预组，9891例随机分为对照组。干预组的筛查摄取率为26.3%（9843例中有2592例），对照组为17.4%（9891例中有1719例）（相对危险度[RR]， 1.51; 95% CI, 1.43-1.60）。虽然各组摄取的绝对差异因筛查史而变化不大，但距离上次Papanicolaou检查时间越长，相对影响越大（未进行Papanicolaou检查：RRs为1.85-3.25；≥10年：RRs为2.78；5-10年：RRs为1.69-1.86;<5年：RRs为1.29-1.37）。逾期患者（RR, 2.03; 95% CI, 1.73-2.38）与最新乳房x光检查患者（RR, 1.53; 95% CI, 1.41-1.67）的相对影响更大，尽管最新组的绝对差异更大。年龄差异不显著，30 - 54岁参与者的5年年龄组rr为1.33 - 1.48,55 - 59岁参与者的rr为1.60 (95% CI, 1.40-1.82)， 60 - 64岁参与者的rr为1.77 （95% CI, 1.56-2.01）。在邮寄的试剂盒中，试剂盒的使用与临床筛查在年龄、种族、计划登记持续时间、未筛查持续时间和结直肠癌筛查依从性方面存在差异。在这项随机临床试验的二级分析中，所有亚组在筛查摄取方面都观察到临床重要的改善。干预效果的大小和试剂盒使用的差异突出了优化优先群体的HPV自采样的机会。ClinicalTrials.gov标识符：NCT02005510
This randomized clinical trial evaluates the association between patient characteristics and effectiveness of a mailed human papillomavirus self-sampling kit intervention on screening uptake. Is the effectiveness of mailed human papillomavirus self-sampling kits vs usual care (in-clinic screening reminders) on cervical cancer screening uptake modified by patient characteristics? In this secondary analysis of randomized clinical trial data, mailed kits were associated with significantly increased screening vs usual care within all subgroups of age, race and ethnicity, screening history, and other sociodemographic and health characteristics. Relative effects were greater with longer vs shorter duration of underscreening. These findings suggest mailing kits increases screening across patient characteristics, with opportunities to optimize self-sampling for priority subgroups. Mailing human papillomavirus (HPV) self-sampling kits increases cervical cancer screening participation, but effects may differ across subpopulations. Subpopulation data can inform US health care system implementation. To identify patient characteristics that modify effectiveness of a mailed kit intervention at increasing screening. This was a secondary analysis of data from the Home-Based Options to Make Cervical Cancer Screening Easy (HOME) randomized clinical trial conducted from 2014 to 2018 at Kaiser Permanente Washington. Data analysis was performed from March 2018 to May 2022. Individuals aged 30 to 64 years with female sex, health plan enrollment longer than 3 years and 5 months, a current primary care clinician, and no Papanicolaou test within the prior 3 years and 5 months were identified through electronic medical records and randomized (1:1) to the control or intervention group. The control group received usual care Papanicolaou screening reminders and outreach. The intervention group received usual care plus an unsolicited mailed HPV self-sampling kit. Screening uptake was captured within 6 months after randomization. Baseline patient characteristics (age, race, ethnicity, travel time to clinic, income, body mass index, tobacco use, health plan enrollment duration, time since last Papanicolaou test, mammography, comorbidities, and colorectal cancer screening adherence) were extracted from the electronic medical record. Of 19 734 individuals (mean [SD] age, 50.1 [9.5] years; 14 129 [71.6%] White), 9843 were randomized to the intervention group, and 9891 were randomized to the control group. Screening uptake was 26.3% (2592 of 9843 individuals) in the intervention group vs 17.4% (1719 of 9891 individuals) in the control group (relative risk [RR], 1.51; 95% CI, 1.43-1.60). Although absolute differences in uptake by group varied little by screening history, relative effects were greater with longer vs shorter time since last Papanicolaou test (no prior Papanicolaou test: RRs, 1.85-3.25; ≥10 years: RR, 2.78; 5-10 years: RRs, 1.69-1.86; <5 years: RRs 1.29-1.37). Relative effects were greater in participants overdue (RR, 2.03; 95% CI, 1.73-2.38) vs up-to-date with mammography (RR, 1.53; 95% CI, 1.41-1.67), although absolute difference was greater in the up-to-date group. Differences by age were not significant, with RRs of 1.33 to 1.48 across 5-year age groups in participants 30 to 54, vs 1.60 (95% CI, 1.40-1.82) in participants 55 to 59 and 1.77 (95% CI, 1.56-2.01) in participants 60 to 64 years. Among those mailed kits, there were differences in kit use vs in-clinic screening by age, race, plan enrollment duration, underscreening duration, and colorectal cancer screening adherence. In this secondary analysis of a randomized clinical trial, clinically important improvements in screening uptake were observed for all subgroups. Differences in magnitude of intervention effect and kit use highlighted opportunities to optimize HPV self-sampling for priority groups. ClinicalTrials.gov Identifier: NCT02005510
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DOI：
10.1093/jamia/ocab199
发表时间：
2021-12-28
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Cook LA;Sachs J;Weiskopf NG
通讯作者：
Weiskopf NG
影响因子：
3.9
作者：
Adegboyega, Adebola;Wiggins, Amanda T;Williams, Lovoria B;Dignan, Mark
通讯作者：
Dignan, Mark
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
12.7
作者：
JANERICH, DT;HADJIMICHAEL, O;POLEDNAK, AP
通讯作者：
POLEDNAK, AP
影响因子：
6.2
作者：
Datta, GD;Colditz, GA;Rosenberg, L
通讯作者：
Rosenberg, L