A randomized controlled trial of a tailored navigation and a standard intervention in colorectal cancer screening.
A randomized controlled trial of a tailored navigation and a standard intervention in colorectal cancer screening.
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DOI：
10.1158/1055-9965.epi-12-0701
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发表时间：
2013-01
期刊：
影响因子：
--
通讯作者：
Andrel J
中科院分区：
文献类型：
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作者：
Myers RE;Bittner-Fagan H;Daskalakis C;Sifri R;Vernon SW;Cocroft J;Dicarlo M;Katurakes N;Andrel J
这项随机对照试验评估了定制导航干预与标准邮寄干预对结直肠癌（CRC）筛查依从性和筛查决策阶段（SDS）的影响。对初级护理患者（n=945）进行了调查，并将其随机分配至定制导航干预（TNI）组（n=312）、标准干预（SI）组（n=316）或常规护理对照组（n=317）。TNI组参与者根据报告的测试偏好发送结肠镜检查说明和/或粪便血液测试，并收到导航电话。向SI组发送结肠镜检查说明和粪便血液检查。多变量分析评估了干预对6个月时SDS依从性和变化的影响。主要结局，筛查依从性（TNI组：38%，SI组：33%，对照组：12%），干预接受者高于对照组（分别为p=0.001和p=0.001），但两个干预组无显著差异（p=0.201）。干预组SDS阳性变化（TNI组：+45%，SI组：+37%，对照组：+23%）显著高于对照组（分别为p=0.001和p=0.001），干预组差异接近显著性（p=0.053）。二次分析表明，定制的导航提高了首选的测试使用，并表明干预对依从性和SDS的影响被有限的筛选选项所削弱。与常规护理相比，这两种干预措施对结果有显著的积极影响。TNI与SI的影响对依从性有适度的积极影响，对SDS有明显的影响。邮寄筛选测试可以提高依从性。需要研究来确定偏好、访问和导航如何影响筛查结果。
This randomized, controlled trial assessed the impact of a tailored navigation intervention versus a standard mailed intervention on colorectal cancer (CRC) screening adherence and screening decision stage (SDS). Primary care patients (n=945) were surveyed and randomized to a Tailored Navigation Intervention (TNI) Group (n=312), Standard Intervention (SI) Group (n=316), or usual care Control Group (n=317). TNI Group participants were sent colonoscopy instructions and/or stool blood tests according to reported test preference, and received a navigation call. The SI Group was sent both colonoscopy instructions and stool blood tests. Multivariable analyses assessed intervention impact on adherence and change in SDS at 6 months. The primary outcome, screening adherence (TNI Group: 38%, SI Group: 33%, Control Group: 12%), was higher for intervention recipients than controls (p=0.001 and p=0.001, respectively), but the two intervention groups did not differ significantly (p=0.201). Positive SDS change (TNI Group: +45%, SI Group: +37%, and Control Group: +23%) was significantly greater among intervention recipients than controls (p=0.001 and p=0.001, respectively), and the intervention group difference approached significance (p=0.053). Secondary analyses indicate that tailored navigation boosted preferred test use, and suggest that intervention impact on adherence and SDS was attenuated by limited access to screening options. Both interventions had significant, positive effects on outcomes compared to usual care. TNI versus SI impact had a modest positive impact on adherence and a pronounced effect on SDS. Mailed screening tests can boost adherence. Research is needed to determine how preference, access, and navigation affect screening outcomes.