A randomized controlled trial of a multicomponent, targeted, low-literacy educational intervention compared with a nontargeted intervention to boost colorectal cancer screening with fecal immunochemical testing in community clinics
A randomized controlled trial of a multicomponent, targeted, low-literacy educational intervention compared with a nontargeted intervention to boost colorectal cancer screening with fecal immunochemical testing in community clinics
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DOI：
10.1002/cncr.30481
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发表时间：
2017-04-15
期刊：
影响因子：
6.2
通讯作者：
Gwede, Clement K.
中科院分区：
文献类型：
--
作者：
Davis, Stacy N.;Christy, Shannon M.;Gwede, Clement K.
背景本研究的目的是提高粪便免疫化学试验（FIT）对结直肠癌（CRC）筛查的吸收。目前的研究调查的差异影响的多成分，有针对性的，低识字率的教育干预相比，一个标准的，nontargeted educational intervention.METHODSPatients年龄在50至75岁的平均CRC风险，而不是最新的CRC筛查招募从联邦合格的卫生中心或初级保健社区卫生诊所。患者被随机分配到干预条件（靶向光子晶体小册子/DVD加FIT试剂盒）或比较条件（标准疾病控制和预防中心小册子加FIT试剂盒）。主要结果是在干预后180天内进行FIT筛查。在416名参与者中，54%为女性;参与者种族和民族多样（66%为白色，10%为西班牙裔，28%为非洲裔美国人），主要是低收入，并有保险（大多数人有县医疗保险）。总体而言，FIT完成率为81%，干预组78.1%的参与者完成了FIT，而对照组83.5%的参与者完成了FIT（P= 0.17）。在多变量分析中，发现有健康保险是预测缺乏FIT筛查的主要因素（调整后的比值比，2.10; 95%置信区间，1.04-4.26 [P= .04]）。提供FIT测试加教育可以提供关键的推动力，以改善CRC筛查的完成。教育材料的类型（有针对性的与非有针对性的）可能不那么重要。目前的研究结果提供了一个独特的机会，诊所采用FIT和选择类型的患者教育材料的基础上诊所，供应商和患者的喜好。Cancer 2017;123：1390-1400. (c)2016年美国癌症协会。在医疗服务不足的社区中，结直肠癌筛查的差异在一项干预措施中得到解决，以增加粪便免疫化学试验（FIT）的使用。尽管靶向和非靶向干预条件之间的FIT摄取似乎没有任何显著差异，但高FIT摄取率表明提供FIT试剂盒消除了护理的关键障碍。
BACKGROUNDThe objective of the current study was to improve colorectal cancer (CRC) screening uptake with the fecal immunochemical test (FIT). The current study investigated the differential impact of a multicomponent, targeted, low-literacy educational intervention compared with a standard, nontargeted educational intervention.METHODSPatients aged 50 to 75 years who were of average CRC risk and not up-to-date with CRC screening were recruited from either a federally qualified health center or a primary care community health clinic. Patients were randomized to the intervention condition (targeted photonovella booklet/DVD plus FIT kit) or comparison condition (standard Centers for Disease Control and Prevention brochure plus FIT kit). The main outcome was screening with FIT within 180 days of delivery of the intervention.RESULTSOf the 416 participants, 54% were female; the participants were racially and ethnically diverse (66% white, 10% Hispanic, and 28% African American), predominantly of low income, and insured (the majority had county health insurance). Overall, the FIT completion rate was 81%, with 78.1% of participants in the intervention versus 83.5% of those in the comparison condition completing FIT (P= .17). In multivariate analysis, having health insurance was found to be the primary factor predicting a lack of FIT screening (adjusted odds ratio, 2.10; 95% confidence interval, 1.04-4.26 [P= .04]).CONCLUSIONSThe multicomponent, targeted, low-literacy materials were not found to be significantly different or more effective in increasing FIT uptake compared with the nontargeted materials. Provision of a FIT test plus education may provide a key impetus to improve the completion of CRC screening. The type of educational material (targeted vs nontargeted) may matter less. The findings of the current study provide a unique opportunity for clinics to adopt FIT and to choose the type of patient education materials based on clinic, provider, and patient preferences. Cancer 2017;123:1390-1400. (c) 2016 American Cancer Society.Disparities in colorectal cancer screening among medically underserved communities are addressed in an intervention to increase the uptake of the fecal immunochemical test (FIT). Although there do not appear to be any significant differences in FIT uptake between the targeted and nontargeted intervention conditions, high FIT uptake rates suggest that the provision of a FIT kit removes a crucial barrier to care.