Enhancing Prevention Pathways Towards Tribal Colorectal Health

 描述(由申请者提供)：美国印第安人/阿拉斯加原住民(AI/ANS)在与结直肠癌(CRC)相关的发病率、死亡率、诊断阶段和存活率方面经历了严重的健康不平等和差异。最近美国普通人群中结直肠癌发病率和死亡率的下降以及确诊阶段和存活率的提高归功于常规筛查，及时切除息肉，及早发现，及时和适当的治疗。与非西班牙裔白人相比，AI/ANS接受及时、风险和年龄合适的癌症筛查的可能性明显较低，包括推荐的CRC筛查。短期目标是测试连续实施的干预措施的有效性，这些干预措施旨在利用粪便免疫化学测试(FIT)加强年度CRC筛查。连续实施指的是提供常规筛查，而不考虑对较早邀请的回应，以符合国家指南，该指南建议在50-75岁之间进行年度适合度测试。FIT是最合适的，因为根据共识指南，它是一种获得批准的高灵敏度粪便潜血测试，每年提供一次，在提供筛查结肠镜检查的资源有限的印度卫生服务和部落卫生设施中可用。我们将跟踪所有FIT阳性结果，并提供及时和适当的诊断和治疗服务。我们通过测试干预措施来解决筛查差异，这些干预措施旨在利用西南部农村50-75岁的平均风险保留AI之间的匹配度来加强年度CRC筛查。这些干预措施是以理论为依据、以证据为基础的，并根据其强度进行分级。高强度干预将包括导航外展、邮寄的健身工具包、教育材料和随访。 提醒(研究组1)。中等强度的干预将包括邮寄的健身工具包、教育材料和后续提醒(研究组2)。参照组(研究组3)将接受常规护理(筛查建议和诊所就诊时的试剂盒)。我们将使用严谨的研究方法：(A)确定通过完成FIT试剂盒来加强年度CRC筛查的干预措施的有效性；(B)了解对行为改变至关重要的背景相关因素；(C)确定加强常规CRC筛查的最具成本效益的战略；以及(D)制定计划，告知可持续性和可扩展性。这是新墨西哥大学、阿尔伯克基地区印第安人健康委员会(100%由印度人拥有和运营)和西南部农村的六个普韦布洛部落共同努力的结果。该研究团队在与人工智能社区合作开展基于社区的参与性癌症预防研究方面拥有广泛和成功的历史。此外，研究小组认识到整合共同学习过程和从事基于信任的互惠研究的价值。这项研究的结果可能导致结直肠癌筛查的立即增加，并最终减少经历癌症差异和健康不平等的人工智能机构的结直肠癌疾病负担。

 DESCRIPTION (provided by applicant): American Indians/Alaska Natives (AI/ANs) experience significant health inequities and disparities in colorectal cancer (CRC) related incidence, mortality, stage at diagnosis, and survival. Recent reductions in CRC incidence and mortality rates and improvements in stage at diagnosis and survival rates in the general U.S. population have been attributed to routine screening with prompt removal of polyps, early detection, and timely and appropriate treatment. AI/ANs are significantly less likely than non-Hispanic Whites to receive timely and risk- and age-appropriate cancer screenings, including recommended CRC screening. The short-term goal is to test the efficacy of serially implemented interventions designed to enhance annual CRC screening using the fecal immunochemical test (FIT). Serial implementation refers to offering routine screening, irrespective of response to an earlier invitation, in concordance with national guidelines which recommend annual FIT testing between ages 50-75. The FIT is most appropriate because, based on consensus guidelines, it is an approved, high sensitivity fecal occult blood test that is offered annually and is available in Indian Health Service and tribal health facilities where resources to provide screening colonoscopy are limited. We will follow all positive FIT results with timely and appropriate diagnostic and treatment services. We address screening disparities through the testing of interventions designed to enhance annual CRC screening using the FIT among average- risk, on-reservation AIs aged 50-75 in the rural Southwest. The interventions are theory-informed, evidence- based, and graded in their intensity. The high intensity intervention will include navigated outreach, a mailed FIT kit, educational material, and follow-up reminders (Study Group 1). The medium intensity intervention will include a mailed FIT kit, educational material, and follow-up reminders (Study Group 2). The reference group (Study Group 3) will receive usual care (screening recommendation and a FIT kit at a clinic visit). We will use rigorous research methods to: (a) determine the efficacy of interventions to enhance annual CRC screening through completion of the FIT kit; (b) understand contextually relevant factors important for behavior change; (c) identify the most cost-effective strategies to enhance routine CRC screening; and (d) develop plans to inform sustainability and scalability. This is a collaborative effort between the University of New Mexico, the Albuquerque Area Indian Health Board (100% Indian-owned and operated), and six Pueblo Tribes in the rural Southwest. The research team has an extensive and successful history of conducting community based participatory cancer prevention research in collaboration with AI communities. Moreover, the research team recognizes the value of integrating a co-learning process and engaging in trust-based mutually beneficial research. Findings from this research could lead to an immediate increase in CRC screening and ultimately reduce the CRC disease burden among AIs experiencing cancer disparities and health inequities.