Factors Affecting Adherence in a Pragmatic Trial of Annual Fecal Immunochemical Testing for Colorectal Cancer.
Factors Affecting Adherence in a Pragmatic Trial of Annual Fecal Immunochemical Testing for Colorectal Cancer.
复制标题
结直肠癌年度粪便免疫化学检测实用试验中影响依从性的因素。
DOI：
10.1007/s11606-018-4820-0
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发表时间：
2019
影响因子：
5.7
通讯作者：
Coronado,GloriaD
中科院分区：
文献类型：
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作者：
Nielson,CarrieM;Vollmer,WilliamM;Petrik,AmandaF;Keast,ErinM;Green,BeverlyB;Coronado,GloriaD
背景粪便免疫化学试验（FIT）筛查结直肠癌可降低结直肠癌的负担.然而，有效性依赖于每年的依从性，这给诊所工作人员和患者带来了挑战。描述FIT返回率，并确定与FIT依从性相关的因素超过2年，在联邦合格的健康中心的邮寄FIT外展计划。设计嵌套在策略和机会，以阻止结肠癌在优先人群（STOP CRC）试验的观察性研究。5195例患者接受了初始FIT订单，并随访≥ 2年（3574例患者在第二年也有FIT订单）。主要测量FIT每年的回报率以及与FIT依从性相关的患者和社区水平特征。关键结果总体而言，完成FIT订单的比例在患者的第一年为46%，在患者的第二年为41%。在第1年接受FIT订单的5195例患者中，3574例（69%）在第2年也接受了FIT订单（71%的第1年依从者和67%的第1年非依从者，p= 0.009）。在那些在第二年有散客订单的人中，第一年坚持散客订单的人（952/1674，或57%）的散客退货率是那些没有坚持散客订单的人（531/1900，或28%，p < 0.0001）的两倍。与FIT复发几率较高相关的患者水平特征包括基线时FIT筛查史、年龄超过65岁（vs 50-65岁）、当前无烟草使用、近期接受乳房X线检查或流感疫苗、亚洲血统（与非西班牙裔白色相比）和非英语偏好。与较低的FIT回报率相关的唯一邻里因素是患者较大的住宅城市size.ConclusionOur研究结果可以告知定制的程序，以促进FIT回报谁在联邦合格的健康中心接受护理的患者之间.试验注册http：www.clinicaltrials.gov
BackgroundColorectal cancer screening by fecal immunochemical test (FIT) reduces the burden of colorectal cancer. However, effectiveness relies on annual adherence, which presents challenges for clinic staff and patients.ObjectiveDescribe FIT return rates and identify factors associated with FIT adherence over 2 years in a mailed FIT outreach program in federally qualified health centers.DesignObservational study nested in the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) trial. Five thousand one hundred ninety-five patients had an initial FIT order and were followed for ≥ 2 years (3574 also had a FIT order in the second year).Main MeasuresFIT return percent in each year and patient- and neighborhood-level characteristics associated with FIT adherence.Key ResultsOverall, the proportion of FIT orders that were completed was 46% in the patients’ first year and 41% in the patients’ second year. Of the 5195 patients with a FIT order in year 1, 3574 (69%) also had a FIT order in year 2 (71% of year 1 adherers and 67% of year 1 non-adherers,p= 0.009). Among those with a FIT order in the second year, the FIT return rate was about twice as high among those who were adherent in the first year (952/1674, or 57%) as among those who were not (531/1900, or 28%,p< 0.0001). Patient-level characteristics associated with higher odds of FIT return were a history of FIT screening at baseline, age over 65 (vs 50–65), no current tobacco use, recent receipt of a mammogram or flu vaccine, Asian ancestry (compared to non-Hispanic white), and non-English preference. The only neighborhood factor associated with lower FIT return rate was patient’s larger residential city size.ConclusionOur findings can inform the customization of programs to promote FIT return among patients who receive care at federally qualified health centers.Trial Registrationhttp://www.clinicaltrials.gov