Increasing Cervical Cancer Screening Uptake Among Emergency Department Patients

提高急诊科患者的宫颈癌筛查率

• 批准号: 10203889
• 负责人: DAVID H ADLER
• 金额: $ 35.23万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10203889
• 关键词: 21 year old; Accident and Emergency department; Acute; Address; Adherence; Advisory Committees; American; Behavior Therapy; Behavioral; Behavioral Mechanisms; Behavioral Sciences; Cancer Prevention Intervention; Car Phone; Caring; Cells; Cellular Phone; Cervical Cancer Screening; Collaborations; Community Clinical Oncology Program; Control Groups; Development; Education; Educational Background; Emergency Care; Emergency Department patient; Emergency Medicine; Environment; Goals; Grant; Health; Health behavior; Healthy People 2020; Human immunodeficiency virus test; Incidence; Injury; Intention; Intervention; Lesion; Malignant neoplasm of cervix uteri; Mediating; Mediator of activation protein; Mental Depression; Methods; Motivation; Oncology; Participant; Patient Noncompliance; Patients; Persons; Population; Preventive; Preventive service; Primary Health Care; Questionnaires; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Personnel; Risk; Rural; Self Administration; Series; Site; Smoking; Source; Subgroup; Tablet Computer; Tablets; Text Messaging; The Sun; Theory of Change; Treatment Efficacy; United States National Institutes of Health; Woman; Work; base; cervical cancer prevention; cost; design; effectiveness evaluation; effectiveness implementation trial; effectiveness trial; efficacy testing; emergency settings; ethnic minority population; evidence base; follow-up; group intervention; health care availability; implementation intervention; improved; intervention effect; malignant breast neoplasm; mobile computing; novel strategies; palliation; pilot trial; programs; racial minority; recruit; screening; screening guidelines; service intervention; smoking cessation; theories; uptake

PROJECT SUMMARY/ABSTRACT Cervical cancer (CC) is preventable. Still, only 80% of U.S. women report adherence to CC screening guidelines. Lower levels of screening are particularly pronounced among racial and ethnic minorities and patients with lower education levels. The group most likely to be non-adherent with CC screening guidelines is women who use the emergency department (ED) for their usual source of care. The ED setting, therefore, is optimal for the deployment of an intervention to promote CC screening. Short Message Service (SMS) on mobile phones (a.k.a. text messaging) is a low-cost, scalable, and effective means of delivering health behavior interventions. The vast majority of Americans – 95% – own a cell phone, and an estimated 98% of all cell phones have texting capabilities. The overarching goal of the proposed project is to develop a low-cost, scalable SMS intervention to increase CC screening that can be deployed in heterogenous ED settings. The proposed randomized controlled trial will test the efficacy of an SMS- based intervention to increase CC screening uptake among ED patients. Step 1 of the approach is to identify whether the participant is adherent with screening guidelines. Step 2 is to randomize non-adherent participants to one of the two treatment conditions: (1) referral only (control group) or, (2) referral and an SMS-intervention consisting of a series of text messages, grounded in behavioral change theory, aimed at generating intention and motivation to get screened. The investigators’ pilot work demonstrated the feasibility and preliminary efficacy of the proposed approach. To limit costs and increase the scalability of the intervention, determination of adherence with screening guidelines via a self-administered questionnaire on a tablet computer will be evaluated. A total of 1460 non-adherent women, age 21-65, will be recruited from a high-volume urban ED and a low-volume rural ED, randomized among study conditions, and followed-up at 150 days to assess interval CC screening uptake. The Specific Aims of the proposed project are, (1) Compare CC screening uptake between control and intervention groups at follow-up, (2) Compare the impact of in-person (using research staff) vs. self-administered (using a tablet) determination of CC screening adherence on the efficacy of the intervention, and (3) Identify mediators and explore moderators of intervention effects on CC screening at follow-up. The study team has a successful track record of collaboration and combines expertise in CC prevention, emergency medicine, behavioral science, and oncology. This project leverages the universal access setting of the ED to target women most at risk for non-adherence with CC screening guidelines. A low- cost, scalable intervention that is effective in increasing CC screening uptake among this population would decrease CC incidence and save lives. The next step would be a multi-site effectiveness/implementation trial using the NCI Community Oncology Research Program (NCORP) Network.

项目摘要/摘要 宫颈癌(CC)是可以预防的。尽管如此，只有80%的美国女性报告坚持CC筛查 指导方针。较低水平的筛查在种族和少数民族中尤为明显， 文化程度较低的患者。最有可能不遵守CC筛查的人群 指南是指使用急诊科(ED)进行日常护理的女性。边缘 因此，对于部署干预措施以促进CC筛查来说，设置是最佳的。短消息 手机上的服务(短信)(也称为文本消息)是一种低成本、可扩展且有效的方式 提供健康行为干预。绝大多数美国人--95%--拥有手机， 据估计，98%的手机都有短信功能。拟议项目的总体目标是 开发低成本、可扩展的短信干预措施，以增加可部署在 不同的ED设置。拟议的随机对照试验将测试短信的疗效- 以增加ED患者接受CC筛查为基础的干预。该方法的第一步是确定 参与者是否遵守筛选指南。第二步是对不遵守规则的参与者进行随机分组 两种治疗条件之一：(1)仅转诊(对照组)或(2)转诊和短信干预 由一系列短信组成，以行为改变理论为基础，旨在产生意图 以及接受筛查的动机。调查人员的试点工作证明了这一点的可行性和初步 所提出的方法的有效性。为了限制成本并增加干预的可扩展性，决心 通过平板电脑上的自我管理问卷遵守筛查指南的情况将是 已评估。共有1460名年龄在21岁至65岁之间的不依从者妇女将从一个数量庞大的城市教育和教育机构招募 一项低容量的农村ED，在研究条件中随机进行，并在150天内进行随访以评估间隔 CC筛查摄取。拟议项目的具体目标是：(1)比较CC筛查摄取率 在控制组和干预组之间的随访，(2)比较面对面的影响(使用研究 工作人员)与自我给药(使用片剂)确定CC筛查依从性对 干预，以及(3)确定影响CC筛查的中介因素并探索干预效果的调节因素 后续行动。研究团队拥有成功的协作记录，并结合了CC方面的专业知识 预防、急救医学、行为科学和肿瘤学。这个项目利用了通用的 ED的访问设置针对不遵守CC筛查指南的风险最高的女性。一个低点- 在这一人群中有效增加CC筛查接受率的成本、可扩展的干预措施将 降低CC发病率，挽救生命。下一步将是多地点有效性/实施试验 使用NCI社区肿瘤学研究计划(NCORP)网络。