Tailored navigation in colorectal cancer screening
Tailored navigation in colorectal cancer screening
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DOI：
10.1097/mlr.0b013e31817fdf46
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发表时间：
2008-09-01
期刊：
影响因子：
3
通讯作者：
Wolf, Thomas
中科院分区：
文献类型：
--
作者：
Myers, Ronald E.;Hyslop, Terry;Wolf, Thomas
背景：结直肠癌(CRC)筛查未得到充分利用。需要有效的方法来增加筛查的使用率。这项研究试图确定定制导航对初级保健中结直肠癌筛查的影响。方法：研究包括154名初级保健实践患者，他们年龄在50岁或以上，符合结直肠癌筛查条件，并在研究开始前2年内进行过办公室访问。收集了参与者的社会人口学特征、心理社会因素和筛查试验[粪便潜血试验(FOBT)或结肠镜检查]决策阶段的基线电话调查数据。通过比较决策阶段的数据，我们确定了决策阶段最高的测试(即首选筛选测试)。喜欢FOBT的参与者收到了FOBT试剂盒和一份提醒。那些喜欢结肠镜检查的人收到了结肠镜检查说明。在这封邮件之后，研究患者的导航员打了一个电话，引导参与者进行筛查。获得6个月的终点调查和病历资料。进行单变量和多变量分析，以确定筛查和首选筛查测试决策阶段变化的预测因素。结果：在终点，63名(41%)研究参与者进行了筛查。从基线到终点，75名(63%)参与者的总体筛查偏好增加。年龄和感知的显着性和一致性(即筛查是重要和敏感的)是筛查使用的正向显著预测因素(P=0.02和P=0.05)；而只有年龄预测总体筛查偏好的变化(P=0.03)。结论：研究参与者筛查使用和偏好增加。年龄和态度可以预测结果。需要进行随机试验来确定干预对人群的影响。
Background: Colorectal cancer (CRC) screening is underutilized. Effective methods to increase screening use are needed. This study sought to determine the impact of tailored navigation on CRC screening in primary care.Methods: The study included 154 primary care practice patients who were 50 or more years of age, were eligible for CRC screening, and had an office visit within 2 years before study initiation. Baseline telephone survey data were collected on participant sociodemographic characteristics, psychosocial factors, and screening test [fecal occult blood test (FOBT) or colonoscopy] decision stage. By comparing decision stage data, we identified that test with the highest decision stage (ie, preferred screening test). Participants who preferred FOBT were sent an FOBT kit and a reminder. Those preferring colonoscopy were sent colonoscopy instructions. After this mailing, a study patient navigator made a telephone call to guide participants towards screening. Six-month end point survey and medical records data were obtained. Univariable and multivariable analyses were performed to identify predictors of screening and of change in preferred screening test decision stage.Results: At end point, 63 (41%) study participants had screened. From baseline to end point, overall screening preference increased for 75 (63%) participants. Age and perceived salience and coherence (ie, screening is important and sensible) were positive, significant predictors of screening use (P = 0.02 and P = 0.05, respectively); while only age predicted change in overall screening preference (P = 0.03).Conclusions: Study participant screening use and preference increased. Age and attitudes predicted outcomes. Randomized trials are needed to determine intervention impact at the population level.