Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans
Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans
复制标题
DOI：
10.1158/1055-9965.epi-07-0759
复制
发表时间：
2008-04-01
影响因子：
3.8
通讯作者：
Fisher, Deborah A.
中科院分区：
文献类型：
--
作者：
Partin, Melissa R.;Grill, Joseph;Fisher, Deborah A.
目的：本研究的目的是验证使用美国国家癌症研究所结直肠癌筛查问卷进行自我报告的结直肠癌（CRC）筛查。材料与方法：对明尼阿波利斯退伍军人事务（VA）医疗中心的890名年龄在50 ~ 75岁的患者进行邮寄调查。试图对邮件无应答者进行电话管理。VA和非VA记录合并作为参考标准。敏感性、特异性、一致性和报告-记录比（R2R）在提供完整医疗记录的受访者中评估总体和测试特异性CRC依从性。二次分析检查了患者特征、治疗缺失和不确定反应的估计差异，以及是否使用严格或自由的时间间隔来评估一致性。结果：686名调查应答者中有345人有完整的医疗记录。对于总体依从性，敏感性为0.98，特异性为0.59，一致性为0.88，R2R为1.14。粪便隐血试验（FOBT）敏感性为0.82，乙状结肠镜检查敏感性为0.75，结肠镜检查敏感性为0.97，双对比钡灌肠（DCBE）敏感性为0.63。FOBT的特异性为0.89，乙状结肠镜为0.76，结肠镜为0.72，DCBE为0.85。除乙状结肠镜检查（0.76）外，所有检查的一致性为0.80。FOBT的R2R为1.31，乙状结肠镜为1.33，结肠镜为1.42，DCBE为6.13。乙状结肠镜和结肠镜联合检查的R2R较低。在年龄较大、受教育程度较低且无CRC家族史的个体中，多报的情况更为明显。使用自由间隔和将不确定反应视为不粘附（相对于缺失），敏感性和R2R得到改善，但差异无统计学意义。结论：自我报告的CRC筛查有效性在定义决策中通常是可接受和可靠的，但因筛查试验和患者特征而异。
Objective: The aim of the study was to validate self-reported colorectal cancer (CRC) screening using the National Cancer Institute Colorectal Cancer Screening questionnaire.Materials and Methods: 890 patients, ages 50 to 75 years, from the Minneapolis Veterans Affairs (VA) Medical Center were surveyed by mail. Phone administration was attempted with mail nonresponders. VA and nonVA records were combined for the reference standard. Sensitivity, specificity, concordance, and report-to-records ratio (R2R) were estimated for overall and test-specific CRC adherence among respondents providing complete medical records. Secondary analyses examined variation in estimates by patient characteristics, treatment of missing and uncertain responses, and whether a strict or liberal time interval was used for assessing concordance.Results: Complete medical records were available for 345 of the 686 survey responders. For overall adherence, sensitivity was 0.98, specificity was 0.59, concordance was 0.88, and R2R was 1.14. Sensitivity was 0.82 for fecal occult blood test (FOBT), 0.75 for sigmoidoscopy, 0.97 for colonoscopy, and 0.63 for double-contrast barium enema (DCBE). Specificity was 0.89 for FOBT, 0.76 for sigmoidoscopy, 0.72 for colonoscopy, and 0.85 for DCBE. Concordance was >0.80 for all tests other than sigmoidoscopy (0.76). R2R was 1.31 for FOBT, 1.33 for sigmoidoscopy, 1.42 for colonoscopy, and 6.13 for DCBE. The R2R was lower for a combined sigmoidoscopy and colonoscopy measure. Overreporting was more pronounced for older, less-educated individuals with no family history of CRC. Sensitivity and R2R improved using a liberal interval and treating uncertain responses as nonadherent (versus missing), but differences were not statistically significant.Conclusions: Self-reported CRC screening validity is generally acceptable and robust across definitional decisions, but varies by screening test and patient characteristics.